A role for microbial selection in frescoes' deterioration in Tomba degli Scudi in Tarquinia, Italy

Mural paintings in the hypogeal environment of the Tomba degli Scudi in Tarquinia, Italy, show a quite dramatic condition: the plaster mortar lost his cohesion and a white layer coating is spread over almost all the wall surfaces. The aim of this research is to verify if the activity of microorganisms could be one of the main causes of deterioration and if the adopted countermeasures (conventional biocide treatments) are sufficient to stop it. A biocide treatment of the whole environment has been carried out before the conservative intervention and the tomb has been closed for one month. When the tomb was opened again, we sampled the microorganisms present on the frescoes and we identified four Bacillus species and one mould survived to the biocide treatment. These organisms are able to produce spores, a highly resistant biological form, which has permitted the survival despite the biocide treatment. We show that these Bacillus strains are able to produce calcium carbonate and could be responsible for the white deposition that was damaging and covering the entire surface of the frescoes. Our results confirm that the sanitation intervention is non always resolutive and could even be deleterious in selecting harmful microbial communities

Calcite moonmilk of microbial origin in the Etruscan Tomba degli Scudi in Tarquinia, Italy

A white deposit covering the walls in the Stanza degli Scudi of the Tomba degli Scudi, Tarquinia, Italy, has been investigated. In this chamber, which is still preserved from any kind of intervention such as cleaning and sanitization, ancient Etruscans painted shields to celebrate the military power of the Velcha family. Scanning electron microscopy analysis has revealed the presence of characteristic nanostructures corresponding to a calcite secondary mineral deposit called moonmilk. Analysis of the microbial community identified Proteobacteria, Acidobacteria and Actinobacteria as the most common phyla in strong association with the moonmilk needle fibre calcite and nanofibers of calcium carbonate. Employing classical microbiological analysis, we isolated from moonmilk a Streptomyces strain able to deposit gypsum and calcium carbonate on plates, supporting the hypothesis of an essential contribution of microorganisms to the formation of moonmilk

Pelvic and aortic lymphadenectomy.

Pelvic and aortic lymphadenectomy for gynecologic malignancies has changed from a random "picking" of some pelvic and aortic lymph nodes to a well-established technique based on adequate knowledge of the patterns of spread of the primary tumor. The identification of the node groups to remove, the number of nodes to count, and the border of dissection in the different clinical situations make pelvic and aortic lymphadenectomy a reproducible surgical intervention. The large experience accumulated over the years has greatly improved the technique and perioperative and complication management. The improved knowledge of the natural history of gynecologic tumors has refined the indications for lymph node dissection. Today, pelvic and aortic lymphadenectomy is primarily a staging procedure. The therapeutic value of lymphadenectomy is recognized in the surgical treatment of cervical cancer, but it is still under evaluation in ovarian and endometrial tumors

Nerve-Sparing Class III-IV Radical Hysterectomy Urodynamic Study and Surgical Technique

Objective: The aim of this study was to demonstrate the impact of the nerve-sparing radical hysterectomy on the bladder function. Methods: Patients with cervical cancer stage 1B1 to IIB, who underwent type 3 to 4 nerve-sparing radical hysterectomy, were evaluated with urodynamic test before and within 6 months from surgery. Stage IB2 to IIB patients were treated with platinum-based neoadjuvant chemotherapy. Bladder catheter was removed in postoperative day 4, and patients were educated to clean intermittent self-catheterization. Urinary symptoms were evaluated with a questionnaire administered before and 3, 6, and 12 months after surgery. Patients treated with adjuvant chemoradiotherapy were excluded from the study. Results: Fifteen patients (stage IB1, 7; IB2, 3; and IIB, 5) completed the study. Eight (53%) patients were treated with neoadjuvant chemotherapy. Bilateral nerve sparing was feasible in 13 (87%) patients, unilateral in 2 (13%). At postoperative day 10, only 3 (20%) patients continued intermittent self-catheterization. Before surgery, 1 (6.2%) patient had urodynamic symptoms of incontinence, and 3 (20%) had overactive bladder detrusor. Postoperative urodynamic study (median, 4 months; range, 3-6) showed reduced detrusor activity in 8 (53%), overactive detrusor in 4 (27%), and normal profile in 3 (20%) patients. Reduced bladder sensation was observed in 2 (12.5%), and residual urine more than 30% of bladder capacity in 2 (12.5%) patients, respectively. No patient showed de novo incontinence. Bladder compliance was unchanged. Conclusions: The separation of the hypogastric nerve from the parametrium is a feasible surgical step, which can be implemented in the radical hysterectomy technique in different clinical settings. The comparative urodynamic study showed a mild functional impairment in the early postoperative period. The most frequent finding was the reduced detrusor activity observed during the voiding phase, consistent with the straining needed to void reported in the questionnaire. These data suggest that a mild bladder impairment occurs despite the conservation of the hypogastric nerve. Copyright © 2012 by IGCS and ESGO

Shock parameters and shock index during severe post-partum haemorrhage and implications for management: a clinical study

The aim of this study was to report the association between shock severity, laboratory parameters and treatment in patients with severe post-partum haemorrhage (PPH) requiring the transfusion of ≥4 blood unit. Patients were divided into two groups: (1) conservative therapy and (2) emergency post-partum hysterectomy. The aggressive decision was always shared by two consultants. Out of 26,094 deliveries, severe PPH occurred in 34 (0.13%) women, emergency post-partum hysterectomy was required in 13 (0.05%), while 21 (0.08%) were treated conservatively. Grade of shock, shock index (SI) and the number of blood units transfused were significantly higher in the hysterectomy group. No statistically significant difference among the two groups was observed for haemoglobin and coagulation results. The severity of shock was associated with the therapeutic choice in the treatment of severe PPH. Therefore, grade of shock and SI should be taken into consideration by the leading obstetrician in the decision making process toward the emergency hysterectomy.Impact Statement What is already known on this subject? Primary post-partum haemorrhage (PPH) is the leading cause of maternal death in developing and industrialised countries. Emergency post-partum hysterectomy is considered a life-saving procedure performed when the women is experiencing a life-threatening haemorrhage. What the results of this study add? Therapeutic dichotomy between conservative and aggressive approach in severe PPH has not been defined, in particular emergency post-partum hysterectomy timing. Shock index (SI) has been proposed as an indicator of adverse maternal outcome. However, the association between shock parameters and advanced treatment modalities has not yet been reported. In our study, grade of shock, SI and the number of blood units transfused were significantly higher in the patients which needed hysterectomy suggesting that it may have a role in the decision making among conservative and aggressive treatment. No statistically significant difference was observed for haemoglobin and coagulation results. What the implications are of these findings for clinical practice and/or further research? Grade of shock and SI should be taken into consideration in the decision making process toward the emergency hysterectomy in severe PPH. The choice between conservative and aggressive treatment should be based on hemodynamic parameters that may represent, in more accurate way, the severity of blood loss. Nevertheless, these data need further confirmation in a larger study

Implementation of the Four-Category Classification of Cesarean Section Urgency in Clinical Practice. A Prospective Study

Purpose: This study is aimed at investigating the clinical efficacy of the 4-category classification of urgent cesarean section. Methods: Women giving birth from September 2012 to December 2014 were prospectively investigated. Urgency C-section categories were color-coded: red - maternal/fetal life threat; yellow - maternal/fetal compromise, not life-threatening; and green - early delivery necessary. Results were audited. Results: A total of 4,754 women gave birth in the period considered, 1,313 (27.6%) with C-section of which 867 were urgent. The code was red in 0.98% of women, and 91.5% of newborns were delivered <= 30'; yellow in 5.1%; and green in 11.7%. The mean decision-to-delivery interval (DDI) +/- SD was 19.6 +/- 9.5 min, 36.6 +/- 15.3 (p < 0.01), and 80.3 +/- 52.8 (p < 0.01), respectively; and mean umbilical pH was 7.24 +/- 0.10, 7.29 +/- 0.08 (p < 0.05), and 7.33 +/- 0.04 (p < 0.01) in the red, yellow, and green groups, respectively. Two (4.2%) red and 4 (2.2%) yellow newborns were acidotic. Mean DDI +/- SD decreased from 21.7 +/- 9.7 min in the period September 2012 to February 2013 to 17.4 +/- 9.7 min in the period February to December 2014 (p = NS). Conclusions: Four-category classification led to achieving the target time in >90% of category 1 emergency C-sections, and stratified newborns with significantly different acidosis levels