Effetti delle microembolizzazioni nei pazienti sottoposti a TAVI

Il rischio di ictus a seguito di impianto di valvola aortica per via percutanea (TAVI), varia dal 2% al 10%, e si accresce considerando anche eventi clinici transitori e infarti clinicamente silenti evidenziabili con tecniche di neuroimaging. Tali eventi sono attribuibili prevalentemente ad embolizzazioni da placche aterosclerotiche della parete aortica o dalla valvola aortica calcifica, provocate dalla procedura stessa. Gli eventi embolici possono inoltre esercitare i loro effetti anche a livello di altri distretti, tra cui il rene. Scopo dello studio è quello di determinare l’impatto globale e fase-specifico di fenomeni embolici ed emodinamici dei vasi cerebrali durante TAVI mediante monitoraggio intraprocedurale con Doppler Transcranico (TCD), correlandolo sia con eventi clinici neurologici periprocedurali (TIA, ictus), sia con eventuali variazioni dello stato cognitivo e neuropsicologico generale del paziente, e con le neuroimmagini (infarti ed emorragie ad insorgenza acuta). Verrà inoltre valutato l’impatto globale della procedura e, più specificamente, dei fenomeni embolici sulla funzione renale misurandone le variazioni periprocedurali anche mediante l’utilizzo di nuovi marcatori più precoci e sensibili (NGAL). I pazienti verranno arruolati sulla base della valutazione con TCD; i pazienti con almeno una finestra acustica transtemporale adeguata verranno valutati per eventuali controindicazioni alla risonanza magnetica. I pazienti senza adeguata finestra acustica non saranno arruolati. Verrà effettuata valutazione di base preprocedurale di: deficit neurologici focali (mediante la National Institute of Health Stroke Scale, NIHSS), grado di autonomia (mediante la modified Rankin Scale), stato cognitivo generale (mediante Montreal Cognitive Assessment MoCA e Mini Mental State Examination MMSE). I pazienti senza controindicazioni effettueranno RM dell’encefalo prima della TAVI. Durante la procedura di TAVI verrà effettuato monitoraggio continuo con TCD e valutata l’eventuale occorrenza di eventi clinici cerebrovascolari periprocedurali (TIA/stroke). Prima della dimissione verrà ripetuta la valutazione neurologica e dello stato cognitivo, la RM dell’encefalo ed un monitoraggio doppler transcranico della durata di 1 ora. La valutazione della funzione renale verrà effettuata mediante misurazione della creatinina plasmatica preprocedurale e a 48-72 ore dalla procedura, calcolo del filtrato glomerulare secondo formula di Cokroft-Gault, e valutazione dell’NGAL urinario preprocedurale e a 4-6 ore dalla procedura. Ad un mese dalla procedura i pazienti ripeteranno la valutazione neurologica e dello stato cognitivo ed il monitoraggio doppler transcranico. Dopo 6-8 settimane sarà ripetuta la RM dell’encefalo. Da gennaio 2012 a marzo 2012 7 pazienti sono stati arruolati nello studio, e di questi solo uno ha completato la valutazione di neuroimaging. I dati preliminari dello studio pilota sono riportati. Il monitoraggio con doppler TCD ha evidenziato la costante occorrenza di microembolizzazioni durante la procedura di TAVI, che raggiungono il picco durante la fase di impianto della protesi. Non si sono verificati eventi clinici né variazioni dello stato cognitivo. L’unica valutazione di neuroimaging completa effettuata ha evidenziato la comparsa di 2 nuove piccole lesioni focali dopo la procedura, completamente regredite senza esiti al controllo a 2 mesi. La valutazione della funzione renale ha evidenziato una differenza modesta ma significativa dei valori di creatinina, eGFR e NGAL urinario, che rimane nell’ambito subclinico e senza correlazione la quantità di mezzo di contrasto e l’entità delle microembolizzazioni

Temporary vena cava filters in the prevention of pulmonary embolism during total hip arthroplasty

Thromboembolism constitutes one of the most dangerous complications during the immediate postoperative period of prosthetic surgery. Pharmacological prophylaxis and mechanical vascular compression are not always sufficient to protect from this surgical complication. In patients at greatest risk for thromboembolism, often with a positive history for pulmonary embolism, temporary vena cava filters may be used to reduce the incidence of vascular and pulmonary complications. However useful, these filters cannot be routinely used in orthopedic surgery. We present our results with the use of Filcard RFO2 vena cava filters in an open, randomized study of 30 patients

Surveillance of nosocomial infections: a preliminary study on hand hygiene compliance of healthcare workers

The observance of hand hygiene compliance is important to reduce cross-infection by micro-organisms. The aim of this preliminary study was to evaluate the level of hand hygiene in healthcare workers from different departments, with particular emphasis on transient flora. The study was conducted in three departments (Surgery, Intensive Care Unit, Obstetrics and Gynecology) of a hospital in Campania, southern Italy. Over a six-month period, 50 healthcareworkers wererandomly tested. Imprints of palms and fingertips were taken monthly during the morning shift. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Total flora was found in the following CFU means per palm and per five fingertips (95% CI): Obstetrics and Gynecology [palms 130 CFUs (95% CI 85-180); fingertips 125 CFUs (95% CI 92-160)]; ICU [palms 80 CFUs (95% CI 58-99); fingertips 62 CFUs (95% CI 45-82)]; Surgery [palms 75 CFUs (95% CI 41-120); fingertips 70 CFUs (95% CI 52-90)] Transient flora was found on 39% of healthcare workers?hands. The only factor associated with hand contamination by transient flora was the absence of gloving during healthcare procedure(P=0.02)

Tuberculin skin test and/or interferon gamma release assay: is it still time to debate?

Not available

Surveillance of nosocomial infections: a preliminary study on yeast carriage on hands of healthcare workers

Hospital-acquired fungal infection is increasing. The aim of this preliminary study was to evaluate the frequency and distribution of yeast carriage on the hands of healthcare workers (HCW) from different departments. The study was conducted in three departments (Surgery, Intensive Care Unit, Obstetrics and Gynaecology) of a hospital in Campania, southern Italy. Over a six-month period, 50 healthcare workers were randomly tested. Imprints of palms and fingertips were taken monthly during the morning shift. The plate with yeast was counted and Candida species were identified. Risk factors for hand contamination were determined. Hand carriage of yeast and Candida species in the three departments were found in the following percentages: Surgery (50% and 49%); Intensive Care Unit (61% and 57%); Obstetrics and Gynaecology (65% and 59%). No significant difference in the frequency or distribution of yeast and Candida sp. recovered in the three departments was ascertained by comparing every two months? data, the hand carriage of yeast and Candida species found in the three departments; this varied ? min to max ? according to the following percentages: Surgery [(45%-54%) and (42%-58%)]; Intensive Care Unit [(53%-66%) and (56%-59%)]; Obstetrics and Gynaecology [(62%-69%) and (57%-63%)]. The only factor associated with yeast carriage on the hands of healthcare workers was the absence of gloving during healthcare procedure (p = 0.0192). We conclude that in our study yeast carriage on the HCWs? hands is common in the three departments investigated, but its causes are unclear. Careful use of gloving may reduce pathogenic yeast on hands

On a Rare Cutaneous Metastasis from a Sacrococcygeal Chordoma

Chordomas are rare malignant tumors of notochordal origin and are rare locally aggressive ones with a metastatic potential. The skin rarely is seen as metastatic site. We describe a case of an adult woman with cutaneous metastasis of a primary sacral chordoma excised ten years before, which appeared as a painless cutaneous mass located in the dorsal region. Once removed, the surgical specimen was formalin fixed and in paraffin embedded. Sections were stained with haematoxylin-eosin, and histochemical and immunohistochemical investigations were performed. Histologically, the neoplasia was characterized by cords or single tumor cells with an abundant myxoid stroma, conspicuous pale vacuolated cytoplasm (the classic "physaliphorous cells"), and mild nuclear atypia. Mitotic activity was scanty. At immunohistochemistry, the tumor cells were diffusely positive for S-100 protein, pan-keratins, EMA, and vimentin. A diagnosis of cutaneous metastasis of chordoma was performed. This case illustrates a diagnostic challenge because of the unusual presentation of an already rare tumor

Internet Addiction: a prevention action-research intervention

The aim of this paper was to present an action-research intervention for the prevention of Internet addiction (IA) in schools. Applying a pre-experimental research design model, a total of 90 young subjects (45 males and 45 females) were treated using a peer education programme. The Internet Addiction Test was used as a screening tool pre- and post-treatment and analysed using a paired t-test. The results showed a significant positive difference in the post-treatment values for both males and females. This research highlights the link between IA and cultural and social aspects of the disease in addition to discussing the difficulties of IA prevention.&nbsp

Brown and Beige Adipose Tissue and Aging

Across aging, adipose tissue (AT) changes its quantity and distribution: AT becomes dysfunctional with an increase in production of inflammatory peptides, a decline of those with anti-inflammatory activity and infiltration of macrophages. Adipose organ dysfunction may lead to age-related metabolic alterations. Aging is characterized by an increase in adiposity and a decline in brown adipose tissue (BAT) depots and activity, and UCP1 expression. There are many possible links to age-associated involution of BAT, including the loss of mitochondrial function, impairment of the sympathetic nervous system, age-induced alteration of brown adipogenic stem/progenitor cell function and changes in endocrine signals. Aging is also associated with a reduction in beige adipocyte formation. Beige adipocytes are known to differentiate from a sub-population of progenitors resident in white adipose tissue (WAT); a defective ability of progenitor cells to proliferate and differentiate has been hypothesized with aging. The loss of beige adipocytes with age may be caused by changes in trophic factors in the adipose tissue microenvironment, which regulate progenitor cell proliferation and differentiation. This review focuses on possible mechanisms involved in the reduction of BAT and beige activity with aging, along with possible targets for age-related metabolic disease therapy

Encroachment analysis of the invasive tree species Ailanthus altissima in Sicily (Italy) through an Ecohydrological cellular automata model

Plant species diversity is fundamental for the stability and resilience of ecosystems, and the well-being of the entire planet. Healthy and diverse ecosystems also contribute to air and water pollution removal, climate regulation and flood prevention. In the last century, plant biodiversity has been facing severe threats, such as habitat destruction and fragmentation due to increasing urbanization, deforestation, agricultural expansion, wildfires, and pollution. In addition, changes in climate pose significant threats to plants biodiversity conservation and native species preservation. All these natural and anthropic disturbance factors are profoundly modifying the competitive dynamics among plant species, often favouring the establishment and spread of some invasive plants, and exacerbating the biodiversity loss of native ecosystems. A well-known invasive alien species is Ailanthus altissima, a tree native to East Asia and introduced to various regions around the world, including North America and Europe. It is characterized by rapid growth, high reproductive capacity, and ability to thrive in a wide range of environmental conditions, where it can significantly modify ecosystems by altering soil characteristics, releasing allelopathic chemicals that may inhibit the growth of other plants, and forming dense thickets that reduce the space available and development chance of native vegetation. Ailanthus has been recognized as the most widespread and invasive alien tree species in Sicily (Italy), with a capillary presence over the entire regional territory, where it poses a serious threat to the biodiversity of the local Mediterranean ecosystems. Ecohydrological models can simulate vegetation dynamics and predict Ailanthus encroachment mechanisms also in presence of disturbance effects and under climate change. In this work, the CATGraSS, an ecohydrological Cellular Automata model (Zhou et al., 2013), has been used for simulating spatio-temporal dynamics of Ailanthus altissima in a specific site of “Vallone di Piano della Corte” Nature Reserve, in the Erei mountains in central Sicily (Italy). The study area has a surface of approximately 1 km2 and it is characterized by a relevant nucleus of Ailanthus that has been growing rapidly in recent years. The study aims to reconstruct Ailanthus altissima spatio-temporal evolution in the study area over the last century. The model has been calibrated using the current Ailanthus distribution maps, obtained by classifying high-quality satellite images, collected by PlanetScope constellation, exploiting modern remote sensing techniques, together with field surveys

Chemical risk in hospital settings: Overview on monitoring strategies and international regulatory aspects

Chemical risk in hospital settings is a growing concern that health professionals and supervisory authorities must deal with daily. Exposure to chemical risk is quite different depending on the hospital department involved and might origin from multiple sources, such as the use of sterilizing agents, disinfectants, detergents, solvents, heavy metals, dangerous drugs, and anesthetic gases. Improving prevention procedures and constantly monitoring the presence and level of potentially toxic substances, both in workers (biological monitoring) and in working environments (environmental monitoring), might significantly reduce the risk of exposure and contaminations. The purpose of this article is to present an overview on this subject, which includes the current international regulations, the chemical pollutants to which medical and paramedical personnel are mainly exposed, and the strategies developed to improve safety conditions for all healthcare workers.&nbsp