Ultrabiomicroscopy anterior segment evaluation of ocular contusive trauma caused by pressurized bottled drink caps. a case report

We report the case of a patient presented to the emergency department because of a contu-sive trauma from a pressurized bottled drink cap. During the visit, the patient indicated that he had been hit in his left eye by a cork while he was opening a sparkling wine bottle. He underwent a total ophthalmology examination. He had an important reduction of visual acuity, corneal swelling, Descemet’s folds, and hyphema. Therefore, we decided to perform ultrabio-microscopy (UBM) of the anterior segment to study the endothelial damage and Descemet’s membrane. UBM images confirmed the direct biomicroscopy, highlighting the damaged loca-tion

Ocriplasmin in the treatment of vitreomacular traction in a patient with central retinal vein occlusion. a case report

Aim: To investigate the efficacy of intravitreal injection of ocriplasmin (JETREA®) in the treat-ment of vitreomacular traction (VMT). Materials and Methods: An 81-year-old man with VMT associated with central retinal vein occlusion in his left eye, was treated with a single intravitreal injection of ocriplasmin (25 μg). Best corrected visual acuity (BCVA), ocular fundus, and optical coherence tomography were examined before and after treatment. Results: Complete release of VMT produced a reduction of central macular thickness, ranging from 459 to 141 μm. BCVA remained stable. Discussion and Conclusions: The use of ocriplasmin was effective in the treatment of VMT. Ocriplasmin represents a valid alternative to conventional pars plana vitrec-tomy

Validation Procedure for Predictive Functions of Driver Behaviour on Two-Lane Rural Roads

The study presented here aims to validate some operating speed prediction models calibrated on two-lane rural roads by using speed data collected in Northern and Southern Italy. Operating speed is defined as the speed at which drivers of passenger cars travel on a dry road in free flow conditions during daylight hours and it is calculated using a specific percentile of speed distribution, typically the 85th. Speed measurements were carried out by using laser detectors in connection with previous environmental and traffic conditions. The study is addressed to emphasize the reliability and easy application of one predictive speed model working both on tangent segments and on circular curves. The calibration phase involved roads in the Northern Italy, while the validation phase involved roads in the Southern Italy. Three models were validated applying them on eight two-lane rural roads falling within the road network of the Province of Salerno with features that reflect those adopted in the calibration phase; the selected models to be validated present the simplest analytical structure for type and number of explanatory variables and for the performance diagram shape of the operating speed values. The validation procedure was to estimate some synthetic statistical parameters as mean absolute deviation, mean squared error and coefficient of variation. The results allow in a simple way to trace continuous operating speed profiles on two-lane rural roads and to carry out safety analyses on the horizontal alignment

The impact of endodontic anatomy on clinical practice: a micro-CT study and tribute to Prof. Francesco Riitano

Aim: To evaluate the quality of root canal preparation using two different mechanical NiTi systems. Methodology: 40 maxillary and mandibular molars were selected. Specimens were randomly assigned to two groups and were scanned using a micro-computed tomography scanner before and after root canal preparation that was performed using ProFile instrument sequence and Reciproc single file technique. Each system was used to obtain an optimal apical size for each specimen, following common clinical guidelines. 3D models were reconstructed and evaluated for volume, areas and root canal axis. The total volume of dentine removed and the volume of the coronal, middle and apical thirds of each root canal were calculated, as well as the average deviation of the root canal axis at different levels and the values compared. Student t-test was used to determine the difference between the two experimental groups (P < 0.05). A qualitative evaluation of root canal preparation was also performed. Results: No statistically significant differences were noted between the groups in the volume of dentine removed after root canal preparation, except for the volume of the coronal third (P < 0.05) and the volume of the apical third (P < 0.05) of the disto-buccal canal of maxillary molars and in the mesial canals of mandibular molars, where ProFile instruments produced significantly less enlarged canal volume in the apical third and more enlarged canal volume in the coronal third (P < 0.05). No statistically significant differences were found in the root canal axis deviation. Conclusions: Under the conditions of this study, both the systems analyzed were able to prepare molar teeth with similar amount of dentine removal and a relatively low risk of procedural errors

Cardiorenal Syndromes and Sepsis

The cardiorenal syndrome is a clinical and pathophysiological entity defined as the concomitant presence of renal and cardiovascular dysfunction. In patients with severe sepsis and septic shock, acute cardiovascular, and renal derangements are common, that is, the septic cardiorenal syndrome. The aim of this paper is to describe the pathophysiology and clinical features of septic cardiorenal syndrome in light of the actual clinical and experimental evidence. In particular, the importance of systemic and intrarenal endothelial dysfunction, alterations of kidney perfusion, and myocardial function, organ “crosstalk” and ubiquitous inflammatory injury have been extensively reviewed in light of their role in cardiorenal syndrome etiology. Treatment includes early and targeted optimization of hemodynamics to reverse systemic hypotension and restore urinary output. In case of persistent renal impairment, renal replacement therapy may be used to remove cytokines and restore renal function

Motorway Speed Management in Southern Italy

AbstractComparing operating speed (V85) with the theoretical design speeds makes many of the assessments fundamental to correct design more effective. In technical literature various models for estimatingV85 are present but they cannot be extended to motorways without risking substantial approximation. This study proposes a model for estimating V85 on motorways. In addition, it proposes a second model making it possible to estimate free flow speed (FFS) in various traffic conditions. This could be very useful for Level of Service studies on motorways

Transverse cervical megapophysis as an uncommon cause of torticollis

Congenital abnormalities of the spine are not uncommon in the general population and can be asymptomatic. Transverse megapophysis is a congenital anomaly manifested as an enlargement of the transverse processes, typically common in the lumbar vertebrae. Here, we describe a 4-month-old infant female with episodes of shooting pain and torticollis. At the beginning of the third month, the parents noticed she held her neck inclined towards the left side in a changeable way, and movement caused discomfort and crying. Muscular tonus, laboratory investigations, ECG and heart and transfontanellar ultrasound were normal. A cervical CT and MRI displayed at the C7 level a megapophysis transverse involving both sides. Treatment with no steroidal anti-inflammatory drugs twice a day and, after a few days, symptoms solved. At 8 months follow-up, neck maintains its natural position and no unmotivated pain has been noticed. Transverse C7 megapophysis presenting with torticollis is an example of a cause of severe pain in infancy, and it should be considered in the differential diagnosis of infantile torticollis. Keywords: Transverse cervical megapophysis, Torticollis, Bertolotti syndrom

Epidemiology, associated factors and outcomes of ICU-acquired infections caused by Gram-negative bacteria in critically ill patients: An observational, retrospective study

BACKGROUND: Gram-negative bacteria are increasingly responsible for nosocomial infections, including ICU-acquired infections. Due to high virulence, rate of multi-drug resistance and limited availability of new agents, these infections create cumbersome clinical burdens, making it important to reduce the risk of their occurrence. The aim of the study was to assess epidemiology-related factors and outcomes of Gram-negative, ICU-acquired infections in a cohort of medical-surgical patients. METHODS: A retrospective survey was conducted on all patients admitted to a mixed ICU from January 2012 to December 2013. ‘ICU-acquired infections’ were defined as new infections acquired no less than 48 h after ICU admission. Diagnosis was made according to the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC/NHSN) criteria. Differences across patients who did and did not acquire a Gram-negative infection were tested regarding age, sex, body mass index, medical or surgical admission, cardiovascular comorbidities, chronic obstructive pulmonary disease, diabetes, end-stage renal failure, co-existing tumours and prophylactic anti-fungal treatment. Multivariate analysis was used to assess the independency of these associations. Finally, differences in ICU-mortality, ICU-length of stay and duration of mechanical ventilation were tested across patients with and without new, ICU-acquired, Gram-negative infections. RESULTS: Of 494 patients admitted to the ICU, 46 (9.3 %) acquired an infection 48 or more hours after admittance. In 30/46 patients (65.2 %) the isolated bacterium was Gram-negative. Univariate analysis showed that clinical factors associated with new ICU-acquired Gram-negative infections were medical admission (p < 0.001, 95 % CI 0.59 – 0.29, OR = 0.13), chronic kidney disease (p = 0.018, 95 % CI 1.20 – 7.34, OR = 2.98) and prophylactic antifungal therapy (p < 0.001, 95 % CI 1.91 – 9.79, OR = 4.33). At multivariate analysis, only medical admission and prophylactic antifungal therapy were significantly associated with ICU-acquired Gram-negative infections. Higher ICU-length of stay and longer duration of mechanical ventilation were associated with these infections while ICU-mortality did not significantly differ. CONCLUSIONS: ICU-acquired Gram-negative infections were common in a cohort of mixed medical-surgical patients. Only medical admission and anti-fungal prophylaxis were found to be independently associated with these infections; they were not found to have a significant effect on ICU-mortality

Precision medicine and precision nursing. The era of biomarkers and precision health

Precision health, by means of the support of precision medicine and precision nursing, is able to support clinical decision making in order to tailor optimal health-care decisions, around the individual characteristics of patients. The operational arm of precision health is represented by the use of biomarkers that can give useful information about disease susceptibility, exposure, evolution and response to treatment. Omics, imaging and clinical biomarkers are actually studied for their ability to positively impact health-care management. In this article, we try to address the role of biomarkers in the context of modern medicine and nursing with the view of improving patients care