Perforated appendix with abscess: Immediate or interval appendectomy? Some examples to explain our choice

Introduction There are no clear guidelines in the treatment of a perforated appendicitis associated with periappendiceal abscess without generalized peritonitis. Presentation of cases We retrospectively studied six examples of treated children in order to discuss the reasons of our team\u2019s therapeutic approach. Some children were treated with a conservative antibiotic therapy to solve acute abdomen pain, planning a routine interval appendectomy after some months. Others, instead, underwent an immediate appendectomy. Discussion By examining these examples we wanted to highlight how the first approach may be associated with shorter surgery time, fewer overall hospital days, faster refeeding and minor complications. Conclusion Our team\u2019s therapeutic choice, in the case of a perforated appendicitis with an abscess and coprolith is an initial conservative case management followed by a routine interval appendectomy performed not later than 4 months after discharge. Abbreviations CT, computed tomography; CVC, central catheter venous; IA, interval appendectomy; NT, naso-gastric tube; US, ultrasonography; VC, vesical cathete

Quantification of intracellular payload release from polymersome nanoparticles

Polymersome nanoparticles (PMs) are attractive candidates for spatio-temporal controlled delivery of therapeutic agents. Although many studies have addressed cellular uptake of solid nanoparticles, there is very little data available on intracellular release of molecules encapsulated in membranous carriers, such as polymersomes. Here, we addressed this by developing a quantitative assay based on the hydrophilic dye, fluorescein. Fluorescein was encapsulated stably in PMs of mean diameter 85 nm, with minimal leakage after sustained dialysis. No fluorescence was detectable from fluorescein PMs, indicating quenching. Following incubation of L929 cells with fluorescein PMs, there was a gradual increase in intracellular fluorescence, indicating PM disruption and cytosolic release of fluorescein. By combining absorbance measurements with flow cytometry, we quantified the real-time intracellular release of a fluorescein at a single-cell resolution. We found that 173 ± 38 polymersomes released their payload per cell, with significant heterogeneity in uptake, despite controlled synchronisation of cell cycle. This novel method for quantification of the release of compounds from nanoparticles provides fundamental information on cellular uptake of nanoparticle-encapsulated compounds. It also illustrates the stochastic nature of population distribution in homogeneous cell populations, a factor that must be taken into account in clinical use of this technology.</p

COVID-19 in rheumatic diseases in Italy: first results from the Italian registry of the Italian Society for Rheumatology (CONTROL-19)

OBJECTIVES: Italy was one of the first countries significantly affected by the coronavirus disease 2019 (COVID-19) epidemic. The Italian Society for Rheumatology promptly launched a retrospective and anonymised data collection to monitor COVID-19 in patients with rheumatic and musculoskeletal diseases (RMDs), the CONTROL-19 surveillance database, which is part of the COVID-19 Global Rheumatology Alliance. METHODS: CONTROL-19 includes patients with RMDs and proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) updated until May 3rd 2020. In this analysis, only molecular diagnoses were included. The data collection covered demographic data, medical history (general and RMD-related), treatments and COVID-19 related features, treatments, and outcome. In this paper, we report the first descriptive data from the CONTROL-19 registry. RESULTS: The population of the first 232 patients (36% males) consisted mainly of elderly patients (mean age 62.2 years), who used corticosteroids (51.7%), and suffered from multi-morbidity (median comorbidities 2). Rheumatoid arthritis was the most frequent disease (34.1%), followed by spondyloarthritis (26.3%), connective tissue disease (21.1%) and vasculitis (11.2%). Most cases had an active disease (69.4%). Clinical presentation of COVID-19 was typical, with systemic symptoms (fever and asthenia) and respiratory symptoms. The overall outcome was severe, with high frequencies of hospitalisation (69.8%), respiratory support oxygen (55.7%), non-invasive ventilation (20.9%) or mechanical ventilation (7.5%), and 19% of deaths. Male patients typically manifested a worse prognosis. Immunomodulatory treatments were not significantly associated with an increased risk of intensive care unit admission/mechanical ventilation/death. CONCLUSIONS: Although the report mainly includes the most severe cases, its temporal and spatial trend supports the validity of the national surveillance system. More complete data are being acquired in order to both test the hypothesis that RMD patients may have a different outcome from that of the general population and determine the safety of immunomodulatory treatments

Polymeric nanoparticles loaded with a Wnt agonist for enhancing bone fracture healing

In the UK, over 2 million people suffer a bone fracture every year. 10% of bone fractures will not heal adequately and require surgical intervention and, as yet, there is no approved systemic drug that is effective in promoting and accelerating fracture healing. Wnt signalling activation is a promising therapeutic target to address this paucity of treatments. Wnt is a molecular pathway that controls bone homeostasis and repair. However, its activation can have both positive and negative effects on bone cell function depending on the timing and site of delivery. Polymersomes (PMs) are polymeric nanoparticles that allow for a spatio-temporal controlled delivery of molecules, including Wnt agonists. This study addresses the hypothesis that PMs loaded with a Wnt agonist can be used as a novel systemic treatment to accelerate bone fracture healing fracture. The aims were: to assess cellular uptake of PMs and to quantify the amount of payload released intracellularly from PMs, to determine the ability of Wnt agonist loaded PMs to promote the osteogenic differentiation of human bone marrow stromal cells (BMSCs), and to assess the distribution of PMs in vivo following systemic injection in a mouse model of bone fracture. Cellular uptake was demonstrated using fluorescein as a model payload. By combining microscopy and flow cytometry, it was demonstrated that PMs are internalised by different cell types, including skeletal stem cells (SSCs), and real-time intracellular release of fluorescein was quantified at a single-cell level. Activation of Wnt signalling was achieved loading PMs with the Wnt agonist 6-bromoindirubin-3’-oxime (BIO), and demonstrated using a luciferase assay and RT-qPCR. In a reporter cell line, BIO-PMs induced a significant activation of the Wnt pathway without cytotoxicity, differently from free BIO. In BMSCs, BIO PMs induced a significant increase in the expression of the Wnt target gene AXIN2 (p&lt;0.05) and in the expression of the early osteogenic marker RUNX2 (p&lt;0.05). Biodistribution in vivo was assessed loading PMs with a fluorescent dye (DiR) and using IVIS and histological analysis. PMs localised in the fractured bone within 24 hours after systemic administration in mice with a femoral drill defect and reached the maximum of accumulation after 48 hours. Histological sectioning confirmed the presence of PMs in the defect area post injection. Preliminary results demonstrated that BIO-PMs injected systemically have the ability to promote bone formation after injury. This project demonstrated that PMs are internalised by SSCs, which are the ideal cellular targets for bone regenerative approaches. When loaded with Wnt agonists, PMs induce a controlled activation of the pathway, promoting osteogenic differentiation of BMSCs. Upon systemic injection in vivo, PMs accumulate at the fracture site and were able to promote bone formation. Overall, the novel and exciting findings presented in this project showed that PMs loaded with Wnt agonists could represent an effective pharmacological treatment to promote bone regeneration after fracture

Joint observation of coherent coda waves at surface and underground arrays.

Local and regional seismicity jointly recorded by two dense small aperture arrays, one in- stalled at surface and one at 1.3 km depth, constitutes an interesting data set useful for coda observations. Applying array techniques to earthquakes recorded at the two arrays we measure slowness, backazimuth and correlation coefficient of the coherent coda wave signals in five fre- quency bands in the range 1–10 Hz. Slowness distributions show marked differences between surface and underground, with slow signals at surface (slowness greater than 1.0 s km−1) that are not observed underground. We interpret these coherent signals as surface waves produced by the interaction of body waves with the free surface characterized by rough topography. The backazimuth values measured in the frequency bands centred at 1.5 and 3 Hz are almost uniformly distributed between 0 and 360◦, while those measured at higher frequencies show different distributions between surface and underground. On the contrary, the earthquake en- velopes show very similar coda shapes between surface and underground recordings, with an almost constant coda-amplitude ratio (between 4 and 8) in a wide frequency range