R(-)-O-desmethylangolensin is the main enantiomeric form of daidzein metabolite produced by human in vitro and in vivo

After ingestion, human intestinal bacteria transform daidzein into dihydrodaidzein, which can be further metabolised to O-desmethylangolensin. This metabolite, unlike daidzein, has a chiral centre and can therefore occur as two distinct enantiomers; however, it is unclear which enantiomer is present in humans. The aim of this study was to define in vitro and in vivo the structure of O-desmethylangolensin and then to evaluate its pharmacokinetic parameters. Daidzein metabolism was preliminarily investigated in anaerobic batch cultures inoculated with mixed faecal bacteria from O-desmethylangolensin producer volunteers. The transformation was monitored by liquid chromatography-mass spectrometry and a chiral column was used to distinguish dihydrodaidzein and O-desmethylangolensin enantiomers. These were purified, analysed by circular dichroism and the results established R(-)-O-desmethylangolensin as the main product (enantiomer excess 91%). However, both dihydrodaidzein enantiomers were detected. Similar results were obtained by in vivo trials. The in vitro formation of O-desmethylangolensin seems to be directly correlated with the number of transforming microorganisms. This correlation was found in vivo for tmax but not for other pharmacokinetic indexes. The pharmacokinetics of daidzein, dihydrodaidzein and O-desmethylangolensin were then evaluated in 11 healthy adult O-desmethylangolensin producers after the single administration of soy milk containing 100mg daidzein. The conjugated forms of daidzein, dihydrodaidzein and O-desmethylangolensin represent more than 90 and 95% of the plasmatic and urinary forms, respectively. The Cmax, tmax and half-life of O-desmethylangolensin in plasma were 62\ub153nM, 28\ub111 and 15\ub16h, respectively. Relevant inter-individual variations were observed as indicated by the high standard deviations

Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders Attualità in tema di petrosectomia subtotale con impianto cocleare nelle patologie croniche dellorecchio medio recalcitranti

Obiettivo. Stabilire la sicurezza ed efficacia dell’intervento di petrosectomia subtotale con posizionamento di impianto cocleare nei pazienti affetti da patologia cronica dell’orecchio medio refrattaria a precedenti trattamenti chirurgici. Metodi. È stato svolto uno studio retrospettivo multicentrico riguardante quei pazienti af- fetti da patologie croniche dell’orecchio medio recalcitranti, sottoposti a petrosectomia subtotale con posizionamento di impianto cocleare. Le informazioni sono state raccolte dai database di 11 centri di riferimento di III livello in Italia. A complemento, è stata svolta una revisione della più recente letteratura. Risultati. Nello studio sono stati inclusi 55 pazienti con un follow-up medio di 44 mesi. Il colesteatoma ha rappresentato la più comune pato- logia ricorrente dell’orecchio medio e il 50,9% dei pazienti aveva una cavità aperta. L’80% dei pazienti è stato sottoposto ad una chirurgia a singolo stadio. Sette pazienti hanno mostrato complicanze post-operatorie, di cui un caso di espianto. Conclusioni. L’intervento di petrosectomia subtotale con posizionamento di impianto cocleare rappresenta una tecnica chirurgica di riferimento per la gestione dei pazienti affetti da otite media cronica recalcitrante. L’intervento chirurgico a singolo stadio è la strategia più frequentemente raccomandata. Il follow-up ottimale è ancora ad oggi oggetto di dibattito. Sono richiesti ulteriori studi per stabilire il ruolo di questo intervento nei pazienti pediatrici.Objective. To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods. A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combination with subtotal petrosectomy. Patients’ details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results. 55 patients were included with a mean follow-up time of 44 months. Cholesteatoma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions. Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients

ACTA OTORHINOLARYNGOLOGICA ITALICA

La malattia MYH9-correlata è una rara sindrome genetica caratterizzata da piastrinopenia congenita associata al rischio di sviluppare, durante linfanzia o letà adulta, ipoacusia neurosensoriale, nefropatia e cataratta presenile ad andamento evolutivo. Furono inclusi in uno studio retrospettivo tutti i casi con sordità da severa a profonda arruolati consecutivamente nel Registro Italiano dei pazienti affetti da malattia MYH9-correlata. La popolazione esaminata coinvolse 147 pazienti Italiani con malattia MYH9-correlata: lipoacusia fu identificata nel 52% dei casi e solo 4 pazienti (6%) presentarono un quadro di sordità da severa a profonda alletà media di 33 anni. In tutti i 4 pazienti, la sordità fu associata ad un lieve sanguinamento spontaneo e in 3 pazienti fu accompagnata da un coinvolgimento renale. Limpianto cocleare fu eseguito in 3 casi, con beneficio, in assenza di complicanze maggiori. La diagnosi di malattia MYH9-correlata fu eseguita circa 28 anni dopo la prima manifestazione clinica della malattia che non fu mai sospettata da un otorinolaringoiatra. Saranno discussi gli aspetti clinici e diagnostici di 4 pazienti con sordità da severa a profonda affetti da malattia MYH)-correlata, focalizzando anche le implicazioni terapeutiche

Screening Feline Blood Donors for Bartonella henselae Infection: Comparison between Indirect Immunofluorescent Antibody Test (IFAT) and Polymerase Chain Reaction (PCR) Results

In order to minimize pathogen transmission, all blood do- nors should be appropriately screened for infectious agents. Screening for Bartonella spp. infection in feline blood donors is a recommended practice in veterinary blood banks across the world. The aim of this study was to compare results of an indirect immunofluorescence antibody test (IFAT) in identifying Bartonella henselae antibodies with the results of PCR amplification of Bartonella spp. DNA to establish the best IFAT cut off to identify non-bacteremic cats. A secondary aim of this study was to evaluate demographic and clinicopathologic factors that may be associated with Bartonella henselae infection status. From a population of stray cats in Milan city, 82 serum samples were evaluated by IFAT for Bartonella henselae antibodies and PCR was performed on 90 whole blood samples for amplification of Bartonella spp. DNA. A total of 14/82 (17.1%) samples were seropositive with an IFAT titer 651:64 (cut-off for infection). Bartonella spp. DNA was identified in 11/90 (12.2%) samples by PCR. Overall 20/90 (22.2%) infected cats were identified by either IFAT 651:64 and/or PCR-positive results. Hyperbetaglobulinemia (P=0.02) and originating from zone 2 of Milan city (P=0.03) were statistically associated with positive Bartonella infection status. The overall IFAT sensitivity was 50.0%, specificity 87.5%, positive predictive value 35.7% and negative predictive value was 92.65%. The ROC analysis showed that the area under the curve was 0.747 (P=0.0032) and that an IFAT cut off<1:32 had the highest sensitivity in identifying Bartonella PCR-negative cats. When feline blood donors undergo serological screening for Bartonella henselae infection an IFAT cut off <1:32 has the highest sensitivity for identifying non-bacteremic cats. However some serologically negative cats could be bacteremic and therefore screening of a feline blood donor using a combination of IFAT and PCR is recommended. Protein electrophoresis should be performed in all potential donor cats

Review of 1,447 Breast Augmentation Patients Using PERTHESE Silicone Implants

Introduction A survey of surgeons in Brazil on their experience with PERTHESE silicone breast implants was performed. Materials and methods Surgeons that used PERTHESE implants between 2002 and 2008 were surveyed on the shape and volume of the implants used, surgical incision site, surgical plane of insertion, key postoperative complications, and surgeon and patient satisfaction. Results The survey had a response rate of 20%, with ten surgeons reporting data on 1447 patients. The majority of the implants used were 200-300 cc, round, and high profile. Preference for the traditional inframammary incision site (47% of patients) was favored over transaxillary (33%) and periareolar (19%), and both subglandular (55%) and submuscular (44%) planes of insertion were used. Over 97% of surgeons and patients were satisfied with the results and surgeons indicated that the implants were easy to use. Conclusions This review demonstrates that these implants are safe, maybe easier to introduce than other implants, and result in a high level of surgeon and patient satisfaction.341111

Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders

Objective. To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods. A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combi-nation with subtotal petrosectomy. Patients’ details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results. 55 patients were included with a mean follow-up time of 44 months. Cholestea-toma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions. Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients

Outcomes of interventional sialendoscopy for obstructive salivary gland disorders: an Italian multicentre study

Sebbene le tecniche scialoendoscopiche abbiano assunto un ruolo fondamentale nel trattamento delle patologie ostruttive dei dotti salivari, in letteratura sono riportati pochi studi multicentrici sullargomento. Questo studio basato sullesperienza di 9 centri italiani è stato condotto su 1152 pazienti (553 donne, età media di 50 anni) per un totale di 1342 procedure scialoendoscopiche, il 44,6% delle quali a carico della ghiandola parotide. Il 12% dei pazienti è stato sottoposto a più interventi. I calcoli salivari sono risultati essere la principale causa di ostruzione (55%), seguiti dalle stenosi e altre malformazioni duttali (16%), dai tappi mucosi (14,5%) e dalla scialodochite (4,7%). La procedura endoscopica è stata portata a termine in 1309 casi mentre in 33 casi è stata interrotta, principalmente a causa della presenza di stenosi duttali complete (21 casi). Dopo una o più procedure il successo terapeutico è stato ottenuto nel 92,5% dei pazienti. Complicanze peri-operatorie e post-operatorie sono state riscontrate nel 5,4% dei casi trattati. La scialoendoscopia rappresenta quindi una procedura efficace e sicura nella diagnosi e nel trattamento delle principali patologie ostruttive dei dotti salivari

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): study protocol for a randomized controlled trial

BACKGROUND: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). METHODS/DESIGN: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure 6430 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. DISCUSSION: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration metho