Infusione continua di detomidina durante chirurgia laparoscopica nel cavallo

RIASSUNTO L’anestesia in stazione quadrupedale è una pratica che permette l’esecuzione di diverse manualità mediche e chirurgiche nel cavallo, senza dover sottoporre il soggetto ai maggiori pericoli di un’anestesia generale. Questa tecnica anestesiologica prevede l’impiego di sedativi in associazione con una tecnica analgesica (somministrazione sistemica, anestesia loco-regionale) qualora la manualità da eseguire comporti l’insorgenza di uno stimolo dolorifico. La laparoscopia prevede l’inserimento intraddominale dei trocar e dello strumentario necessario per eseguire la tecnica. Per evitare danni agli organi da parte dello strumentario in addome, il soggetto deve mantenere una posizione adeguata e non deve effettuare movimenti bruschi. Nello studio è stato formulato un protocollo che ha previsto la sedazione del soggetto mediante la somministrazione di detomidina in associazione con buprenorfina per via endovenosa ed anestesia loco-regionale della porzione interessata dalla chirurgia mediante lidocaina. Per il mantenimento è stata attuata l’infusione endovenosa continua di detomidina con lo scopo di ottenere un livello di sedazione costante nel tempo ed adeguato alla manualità. Infatti la somministrazione di un farmaco per via endovenosa continua permette di variare più rapidamente il livello ematico di questo e, conseguentemente, di poterne modulare gli effetti. La detomidina è un farmaco che produce un accumulo nell’organismo, per cui è stato adottato un protocollo che prevede il dimezzamento il dosaggio dell’infusione ogni quindici minuti. L’impiego di questo protocollo anestesiologico ha permesso di effettuare la procedura laparoscopica senza difficoltà da parte del chirurgo. Il piano analgesico ottenuto è risultato efficace ed adeguato per lo svolgimento della manualità chirurgica. A fine intervento tutti i soggetti hanno ripreso la capacità di deambulare in breve tempo, non presentando complicazioni. SUMMARY Standing horse anesthesia is a practice that allows the execution of medical and surgical techniques, without applying to general anesthesia that is a very stressful and more dangerous event for a horse. In this kind of anesthesia, sedatives are employed in association with an analgesic technique (sistemic analgesia or loco-regional anesthesia) when the practice is supposed to be painful. The abdominal introduction of trocars and of laparoscopic tools is necessary in order to perfom a laparoscopic surgery; for this reason the patient is expected to stand motionless and it is important that it does not make roguh movements during the procedure. The wording of the anesthesia protocol for this study implied the use of detomidine for sedation in association with intravenous buprenorphine as analgesic and loco-regional anesthesia with lidocaine of the surgical area. For the maintenance, detomidine by intravenous continuous infusion was employed with the purpose to obtain a constat sedation level and adequate to the procedure. In fact the constant infusion of drugs permits to change blood concentration more rapidly and consequently it is possible to easily modulate the effects of drugs. Detomidine is a sedative that can accumulate in the organism, so the anesthestic protocol foresaw to halve the dosage every fifteen minutes. This anesthetic protocol provided a good sedation and the laparoscopic technique was performed without problems. The obtained analgesic plan resulted efficacious and adequate for the course of the surgery. At the end of the procedure all the subjects were able rapidly to walk and did not present complications

Biological Characterisation of Superficial Bladder Cancer by Bivariate Cytokeratin 7/DNA Analysis, Flow Cytometric Assessment of MIB-1, and an Immunohistochemical Study

A total of 238 cases of bladder carcinoma stages Ta, Tis, T1 were submitted prospectively to multiparameter flow cytometry and immunohistochemical study in order to determine the biological aggressiveness of the tumour. DNA index (DI), S-phase fraction (SPF) obtained by bivariate cytokeratin 7=DNA analyses, and the immunohistochemical evaluation of p53 and MIB-1 were studied in relation to the traditional prognostic factors in bladder cancer (stage and grade). The variance analysis results showed that DNA aneuploidy was significantly associated with high stage (p = 0:0001), high grade (p = 0:0001), high SPF value ≥5.5% (p = 0:0001), MIB-1 positivity ≥31% (p = 0:0001) and high expression of p53 (staining involving >50% of cells, p = 0:0001). Even if there was no statistical significance the hypotetraploid class (1.707% was strongly associated with aneuploidy (p = 0:0001). The determination of DNA content coupled with the study of the epithelial (cytokeratin 7) and proliferative (MIB-1) markers could be useful in providing important information on the biological behaviour of superficial bladder tumours

Structured headache services as the solution to the ill-health burden of headache. 2. Modelling effectiveness and cost-effectiveness of implementation in Europe: methodology

Background: Health economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions. No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of interventions designed to close treatment gaps for headache disorders in countries of Europe (or elsewhere). Our aim here, within the European Brain Council’s Value-of-Treatment project, was to develop headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Methods: We developed three headache-type-specific decision-analytical models using the WHO-CHOICE framework and adapted these for three European Region country settings (Luxembourg, Russia and Spain), diverse in geographical location, population size, income level and health-care systems and for which we had population-based data. Each model compared current (suboptimal) care vs target care (delivered in accordance with the structured headache services model). Epidemiological and economic data were drawn from studies conducted by the Global Campaign against Headache; data on efficacy of treatments were taken from published randomized controlled trials; assumptions on uptake of treatments, and those made for Healthy Life Year (HLY) calculations and target-care benefits, were agreed with experts. We made annual and 5-year cost estimates from health-care provider (main analyses) and societal (secondary analyses) perspectives (2020 figures, euros). Results: The analytical models were successfully developed and applied to each country setting. Headache-related costs (including use of health-care resources and lost productivity) and health outcomes (HLYs) were mapped across populations. The same calculations were repeated for each alternative (current vs target care). Analyses of the differences in costs and health outcomes between alternatives and the incremental cost-effectiveness ratios are presented elsewhere. Conclusions: This study presents the first headache-type-specific analytical models to evaluate effectiveness and cost-effectiveness of implementing structured headache services in countries in the European Region. The models are robust, and can assist policy makers in allocating health budgets between interventions to maximize the health of populations

Historia arácnida : Simpoiesis, archifósiles y xeno-archivos

Desde el punto de vista de la Historia, si la falta de información es un problema, la extrema abundancia también puede serlo (Caimari, 2017, p.72); como una especie de pánico que sobreviene a quien se enfrente a la monolítica pila de datos, una sensación abrumadora espera en el filo de internet. Si se dejan de lado las explícitas tendencias acumulativas para la monetización, como los casos de Google, Facebook o Amazon, uno de los más llamativos acopios de información digital actual es Internet Archive, dedicada desde mediados de los 90 a recopilar datos en forma de documentos de diversos tipos, muchos de ellos donados por bibliotecas u otras instituciones (Internet Archive, s.f.). Dentro de este inmenso proyecto se encuentra Wayback Machine, dedicada exclusivamente a guardar copias de páginas web en acceso público. Inspirada en la máquina del tiempo WABAC de la serie de animación de Peabody y Sherman (Graham, 28 de enero de 2019), Wayback Machine es al mismo tiempo una ciencia-ficción transformada en realidad y una máquina de acopio que tiende al acaparamiento de datos con una finalidad generalista y una política de adquisición no del todo clara: según sus fundadores y directores, la información que se recopila no tiene un objetivo más que estar allí por si alguien la necesita, sin expurgos ni declinaciones (Internet Archive, s.f.; Graham, 28 de enero de 2019). (Párrafo extraído del texto a modo de resumen)Este capítulo se realizó en el marco del programa de adscripción a la cátedra Teoría de la Historia (2020-2022) y del Proyecto de Investigación "Archivos, Arte y Cultura Visual entre 1980 y 2001. Acervos personales de artistas y diseñadores de la ciudad de La Plata (Segunda parte)". Acreditado como Proyecto Promocional de Investigación y Desarrollo (PPID–UNLP). Período: 2020-2022. B016Facultad de Arte

Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions

Background: There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings. Methods: Data sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness. Results: The models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity. Conclusions: This is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe

The role of autophagy in vernal kerato-conjunctivitis

Autophagy is involved in many biological aspects, including cell survival and death, innate and adaptive immunity and cancer. An involvement of autophagy is also reported in some inflammatory diseases such as asthma. In the present study we explored the role of autophagy in vernal keratoconjunctivitis (VKC), a severe inflammatory disease mainly found in children and adolescents. Autophagy and apoptosis markers (LC3A, LC3B, Beclin-1, cathepsin B, BCL-2, BAX, caspase 3) expression in conjunctival biopsies from 9 active VKC patients and 9 healthy age matched normal subjects were analyzed using immunohistochemistry and qPCR techniques. Conjunctival cells cultures were treated with inflammatory stimuli (IL-1b, histamine, IL-4, TNFa) and analysed by western blotting for autophagy markers expression. LC3B, Catepsin D and B and Beclin-1expression strongly increased in the stroma of VKC whereas the epithelium was consistently negative for all of the molecules studied but positive for Beclin-1 in VKC. qPCR analysis demonstrated a similar mRNAs expression in VKC and normal subjects. In “in vitro” experiments autophagy induction revealed that only LC3B expression was changed in conjunctival fibroblasts by inflammatory stimuli. In particular, both LC3BI, the LC3B free form, and LC3BII, the phosphatidyl-ethanolamine-conjugated form, involved in the autophagosome formation, were decreased in fibroblast cultures at 24h after TNFα stimulation. However, since LC3B-II is normally degraded by lysosomes and the total amount of LC3B-II depends on the balance between its formation and degradation, we analyzed the expression of LC3B-II in the presence and absence of chloroquine, an inhibitor of lysosomal degradation. We found a significant increased amount of LC3BII compared to the control, indicating an over-expression of this protein in stimulated fibroblasts that is quickly damped by its degradation. Since one of the key steps in autophagy is the conversion of LC3B from LC3B-I to LC3B-II, our results suggest that autophagy may be involved in the pathogenesis of VKC

Impacts of air pollution on human and ecosystem health, and implications for the National Emission Ceilings Directive. Insights from Italy

Across the 28 EU member states there were nearly half a million premature deaths in 2015 as a result of exposure to PM2.5, O3 and NO2. To set the target for air quality levels and avoid negative impacts for human and ecosystems health, the National Emission Ceilings Directive (NECD, 2016/2284/EU) sets objectives for emission reduction for SO2, NOx, NMVOCs, NH3 and PM2.5 for each Member State as percentages of reduction to be reached in 2020 and 2030 compared to the emission levels into 2005. One of the innovations of NECD is Article 9, that mentions the issue of “monitoring air pollution impacts” on ecosystems. We provide a clear picture of what is available in term of monitoring network for air pollution impacts on Italian ecosystems, summarizing what has been done to control air pollution and its effects on different ecosystems in Italy. We provide an overview of the impacts of air pollution on health of the Italian population and evaluate opportunities and implementation of Article 9 in the Italian context, as a case study beneficial for all Member States. The results showed that SO42− deposition strongly decreased in all monitoring sites in Italy over the period 1999–2017, while NO3− and NH4+ decreased more slightly. As a consequence, most of the acid-sensitive sites which underwent acidification in the 1980s partially recovered. The O3 concentration at forest sites showed a decreasing trend. Consequently, AOT40 (the metric identified to protect vegetation from ozone pollution) showed a decrease, even if values were still above the limit for forest protection (5000 ppb h−1), while PODy (flux-based metric under discussion as new European legislative standard for forest protection) showed an increase. National scale studies pointed out that PM10 and NO2 induced about 58,000 premature deaths (year 2005), due to cardiovascular and respiratory diseases. The network identified for Italy contains a good number of monitoring sites (6 for terrestrial ecosystem monitoring, 4 for water bodies monitoring and 11 for ozone impact monitoring) distributed over the territory and will produce a high number of monitored parameters for the implementation of the NECD

Bioelectronic recordings of cardiomyocytes with accumulation mode electrolyte gated organic field effect transistors

Versió postprint del document publicat a: https://doi.org/10.1016/j.bios.2019.111844Organic electronic materials offer an untapped potential for novel tools for low-invasive electrophysiological recording and stimulation devices. Such materials combine semiconducting properties with tailored surface chemistry, elastic mechanical properties and chemical stability in water. In this work, we investigate solution processed Electrolyte Gated Organic Field Effect Transistors (EGOFETs) based on a small molecule semiconductor. We demonstrate that EGOFETs based on a blend of soluble organic semiconductor 2,8-Difluoro-5,11-bis(triethylsilylethynyl)anthradithiophene (diF-TES-ADT) combined with an insulating polymer show excellent sensitivity and long-term recording under electrophysiological applications. Our devices can stably record the extracellular potential of human pluripotent stem cell derived cardiomyocyte cells (hPSCs-CMs) for several weeks. In addition, cytotoxicity tests of pharmaceutical drugs, such as Norepinephrine and Verapamil was achieved with excellent sensitivity. This work demonstrates that organic transistors based on organic blends are excellent bioelectronics transducer for extracellular electrical recording of excitable cells and tissues thus providing a valid alternative to electrochemical transistors

Care pathways models and clinical outcomes in disorders of consciousness

Objective: Patients with Disorders of consciousness, are persons with extremely low functioning levels and represent a challenge for health care systems due to their high needs of facilitating environmental factors. Despite a common Italian health care path-way for these patients, no studies have analyzed information on how each region have implemented it in its welfare system correlating data with patients’ clinical outcomes. Materials and Methods: A multicenter observational pilot study was realized. Clinicians collected data on the care pathways of patients with Disorder of consciousness by ask-ing 90 patients’ caregivers to complete an ad hoc questionnaire through a structured phone interview. Questionnaire consisted of three sections: sociodemographic data, description of the care pathway done by the patient, and caregiver evaluation of health services and information received.Results: Seventy- three patients were analyzed. Length of hospital stay was different across the health care models and it was associated with improvement in clinical diag-nosis. In long- term care units, the diagnosis at admission and the number of caregivers available for each patient (median value=3) showed an indirect relationship with worsening probability in clinical outcome. Caregivers reported that communication with professionals (42%) and the answer to the need of information were the most critical points in the acute phase, whereas presence of Non- Governmental Organizations (25%) and availability of psychologists for caregivers (21%) were often missing during long-term care. The 65% of caregivers reported they did not know the UN Convention on the Rights of Persons with Disabilities. Conclusion: This study highlights relevant differences in analyzed models, despite a recommended national pathway of care. Future public health considerations and ac-tions are needed to guarantee equity and standardization of the care process in all European countries