Adnexal Torsion in Pediatric Age: Does Bolli's Score Work? Report of Two Cases

Adnexal torsion is a surgical emergency requiring early diagnosis in order to avoid demolitive surgery. Adnexal torsion's diagnosis could be very difficult in pediatric patients because children cannot explain symptoms accurately. Furthermore reproductive organs lie high in abdomen, causing unclear examinations findings. For reducing diagnostic mistakes or delay clinical and hematological criteria could be useful. No radiological criteria (CT or MRI) should be taken in count because of the costs and the required time. By combining clinical presentation in patients with OT three useful diagnostic variables have been identified: age, duration of pain, vomiting. Presence of vomiting, short duration of abdominal pain and high CRP levels have great predictive value for the diagnosis of adnexal torsion. In those patients an exploratory laparoscopy should be performed without any doubt and/or delay. These data may aid physicians in the evaluation of abdominal pain in premenarchal girls

An Euler-Bernoulli beam element with lumped plasticity applied on RC framed structures

Most of existing reinforced concrete structures suffer due to corrosion of steel and concrete degradation. In many cases existing structures reveal to be inadequate to absorb the expected seismic load and need to be rehabilitated according to the in force code. In the worst case some structures have not been designed to absorb horizontal actions. The rehabilitation process begins with the complete knowledge of its geometrical configuration and the evaluation of the vulnerability of the structure to seismic loads. This analysis permits to identify critical zones and to establish focused strengthening actions. A comparison between the behavior of the structure in the current and in the future configurations determines the goodness of adopted intervention techniques. The evaluation of the vulnerability of an RC structure to seismic loads can be done by performing nonlinear finite element analyses. In literature, three different approaches have been tuned to simulate the elastoplastic behavior of a beam/column element: lumped elastoplasticity models, distributed nonlinearity models, fiber models. Lumped models consider the constitutive nonlinearity concentrated at a section level of a frame element, usually employing nonlinear springs at the ends of beam/column elements. Distributed nonlinearity models average the nonlinearity over a finite element by considering the possibility to form plastic hinges at different evaluation points of the element and calculating weighted integrals of the section responses. Fiber models subdivide a section with a large number of finite elements and nonlinearity is related to the stress-strain relationship of a single finite element. Within lumped models, commercial finite element programs contemplate the possibility to develop plasticity at the two ends of the beam only. In the particular cases where plasticity concentrates in points different than the ends of the beam, it computationally comes in the need to proceed with a re-meshing of the model or in the definition of multiple elements before running the analysis. In the first case, it results in an increased computational cost of the analysis. In the second case, a less precision of the response is obtained especially when the exact position of the plastic hinge is not a-priori known. The present work is devoted to the implementation of a new elastoplastic 3D Euler-Bernoulli beam element including slope discontinuities, in the framework of lumped elastoplasticity models. In the new finite element, plastic hinges can appear at any position of the beam, theoretically in a priori not-established number. Multiple slope discontinuities are included in the analysis through a non uniform bending stiffness of the beam, making use of the Dirac-delta function. Fictitious springs, with a stiffness variable according to the level of plasticity in the section, transfer the correct bending moment in correspondence of plastic hinges.The nonlinear behavior of the hinge is defined in the framework of a thermo-dynamically consistent elastoplastic theory. Associated flow rules are derived in the classical manner adopting a convex activation domain known in literature and experimentally calibrated for reinforced concrete sections. The activation domain is similar to the one suggested by the Italian seismic code. It is given in a My-Mz bending moment reference system for a fixed axial force. An elastoplastic behavior is assumed for section curvatures, while deformations in the axial and shear directions are assumed elastic. The elastoplastic frame element is introduced in a finite element analysis program to run nonlinear simulations on 2D and 3D framed structures. To this end, state equations and flow rules are rewritten in a discrete manner to solve the single iteration of the Newton-Raphson procedure. A classic elastic predictor phase is followed by a plastic corrector phase in the case of activation of the inelastic phenomena. The corrector phase is based on the evaluation of return bending moments by employing the closest point projection method, in order to satisfy the loading-unloading conditions (Kuhn-Tucker relations). The formation of one or more hinges inside a finite element modifies the distribution of internal forces and its stiffness matrix. As a consequence, the global stiffness matrix is continuously modified at each plastic load step until it becomes singular. Numerical examples are furnished as validation tests of the program. The efficiency of the proposed model is demonstrated comparing the results with those available in literature

S-100a0 protein stimulates Ca2+ -induced Ca2+ release from isolated sarcoplasmic reticulum vesicles

AbstractS-100a0 protein, the αα-isoform of the S-100 family, stimulates Ca2+ -induced Ca2+ release from terminal cisternae isolated from rat skeletal muscle cells. The stimulatory effect of S-100a0 is maximal at ∼5 μM S-100a0 and half maximal at ∼0.1 μM S-100a0, at 1.8 μM free Ca2+ in the presence of 5 mM Mg2+ plus 0.1 M KCl. The effect of the protein on Ca2+ -induced Ca2+ release is completely inhibted by the calcium release blocker, ruthenium red

Current exposure of Italian women of reproductive age to PFOS and PFOA: a human biomonitoring study

Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) concentrations were determined in serum samples collected in 2011-2012 from 549 nulliparous Italian women of reproductive age who resided in six different Italian Regions. Assessment of exposure to perfluorinated compounds was part of a large human biomonitoring study (Project Life Plus "Womenbiopop") that aimed at examining the exposure of women of reproductive age to priority organic pollutants. The median concentrations of PFOS and PFOA were 2.43, and 1.55ngg-1, respectively. Significant differences in the concentrations of both compounds were observed among the six Regions. Women from central Italy had the highest levels of both compounds, followed by women from northern Italy, and southern Italy. No differences in the PFOS concentrations were found between women from urban/industrial areas and women from rural areas, whereas the levels of PFOA were significantly higher in women residing in urban/industrial areas than in women residing in rural areas. Taken together, the observed concentrations confirm that the overall exposure of the Italian population is among the lowest observed in industrialized countries. A downward temporal trend in exposure was observed for both compounds when comparing the results from the present study with those assessed in a study conducted in 2008

Am J Prev Med

CC999999/Intramural CDC HHS/United States2017-02-19T00:00:00Z26456878PMC531651

Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

[Abstract] Aims. Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results. We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66±13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion. Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%