Modelling of Thermal Hyperemia in the Skin of Type 2 Diabetic Patients

The microcirculatory response to thermal stimulation involves both an axon reflex and NO-mediated activation. The analysis of the microcirculatory flow following thermal stimulation may therefore enhance the detection of any impairment of the small unmyelinated fibres that are involved in the axon reflex. The aim of this work is to establish a method of non-invasive measurement of small fibre impairment. The microcirculatory flow in response to local heating is measured by using a laser Doppler instrument, and mathematically modelled to extract a set of quantitative parameters. The results confirm that there is a significant difference in the parameters modelling the axon reflex between diabetic and control subjects, while no significant difference is found in the parameters modelling the NO-mediated activation

Gel piastrinico. Trattamento del piede diabetico e dell’osteomielite fistolizzata. Revisione della letteratura e nostra esperienza in 61 casi clinici

GEL PIASTRINICO: TRATTAMENTO DEL PIEDE DIABETICO E DELL’OSTEOMIELITE FISTOLIZZATA. REVISIONE DELLA LETTERATURA E NOSTRA ESPERIENZA IN 61 CASI CLINICI Introduzione: la nostra esperienza evidenzia l’utilità del gel piastrinico (GP) nel trattamento ambulatoriale delle piaghe torpide della pianta del piede in paziente diabetico e delle ulcerazioni torpide che richiedevano periodi lunghissimi di medicazioni complesse, senza raggiungere il risultato atteso. Materiali e Metodi: la metodica personale prevede il curettage dopo disinfezione e debridement della piaga, l’inoculazione di 1-4 UI di insulina pronta alla base del cratere ulcerativo e quindi l’applicazione di 5 ml di GP con 1 ml di Trombina autologa attivata. L’applicazione si esegue facendo gocciolare il concentrato piastrinico su Hyalofill-F Fidia® Italia sul quale si fa, quindi, gocciolare l’attivatore ottenendo un panno morbido, elastico-gelatinoso, pronto a riempire la cavità da trattare. Il supporto inerte riassorbibile in acido ialuronico impedisce la dispersione della parte liquida o non completamente gelificata, ricca dei fattori di crescita (PDGF, TGF, EGF) che stimolano la moltiplicazione dei fibroblasti i quali aumentano di numero e depositano matrice connettivale, trasformando la piaga torpida con la fioritura dei bottoni di granulazione. In caso di ferite più piccole o man mano che l’ampiezza della ferita si riduce, il prodotto può essere aliquotato e congelato per successive somministrazioni. Nel caso di paziente affetto da ulcerazione da osteomielite occorre un lungo periodo di terapia antibiotica parenterale con Ampicillina-Sulbactam o Piperacillina-Tazobactam o Ertapenem o Meropenem associata a Vancomicina, oppure, alternativamente Daptomicina. Discussione: in generale, la terapia deve essere mirata sulla base dell’isolamento del germe patogeno, ma spesso l’infezione è polimicrobica e quindi si somministra una terapia empirica ad ampio spettro. Principio guida nella terapia empirica è la somministrazione di antibiotici contro lo Staphylococcus aureus meticillino resistente (MRSA). Nei pazienti ambulatoriali è essenziale tenere in considerazione la presenza di germi meticillino resistente associati alla comunità di appartenenza (CA-MRSA) e quindi occorrono colture batteriche ripetute. Conclusioni: l’approccio multidisciplinare tra chirurgo, immunotrasfusionista, infettivologo, dermatologo, ortopedico, diabetologo e cardiologo, risolve brillantemente la problematica. Lo stretto coordinamento tra ambulatorio chirurgico ed il centro trasfusionale, evita inutili attese al Paziente, accorcia i tempi di esecuzione della medicazione, abbatte i costi per l’impiego di materiali e diventa conveniente rispetto al trattamento tradizionale.Our study proves the usefulness of platelet gel in the treatment of the diabetic foot. We started in January 2006 to treat diabetic wounds of the foot in the outpatients’ surgical department with encouraging results. Despite its expensive and complex preparation, the platelet gel is useful and convenient because it succeeds in shortening the ambulatory treatment period. Besides, in our opinion, the multidisciplinary approach of this treatment is rather important: actually, it implies the cooperation of dermatologist, surgeon, orthopaedist, immunologist, diabetologist and, if necessary, the cardiologist. That is why it reduces wastes of work-time and the expenses for consultants, medications and dressing material

Cortex excitability, epilepsy and brain illness: which are their correct relationships?

In their work Gilio et al. investigate the mechanisms involved in the regulation of excitability of the cortex in epileptic subjects, and in particular their epileptogenic threshold

Systemic sclerosis and multiple sclerosis

[No abstract available

Requests for electromyography in Rome: a critical evaluation

To date, there exist no data reporting the level of suitability of requests for electromyography examinations (EMGs) in Rome. The records of 1,220 consecutive patients (age: 57.6±15.0 years; 400 M, 820 F) in two neurophysiology laboratories were collected and analyzed. In total, 1,317 EMGs were requested, mainly by general practitioners (GPs) (57%) and orthopedic specialists (18%). The most common diagnoses were L4-L5 radiculopathy (22%) and carpal tunnel syndrome (21%); 332 examinations (25%) were normal. 68% of requests were not accompanied by any specific query. The concordance between initial hypothesis/final post-EMG diagnosis was low (0.05). In 17% of cases, the EMG was deemed diagnostically useless by the neurophysiologist, which seems to indicate potentially suboptimal prescription of EMGs

May diabetes patients have trouble sleeping despite not having obesity?

Obstructive sleep apnea (OSA) and periodic limb movements during sleep (PLMs) are sleep-related disorders with a high prevalence in type 2 diabetes. Commonly OSA is considered as a consequence of obesity, but several previous studies have shown the presence of OSA in non-obese diabetic patients. A previous study showed higher PLMs prevalence in patients with type 2 diabetes, compared to age-matched controls. We speculated that both OSA and PLMs may reflect the presence of diabetic autonomic neuropathy. To test this hypothesis, we compared a group of 112 non-obese patients with type 2 diabetes with 66 age-, sex-, and body mass index- matched nondiabetic patients. Both groups have been investigated through a set of tests including the Epworth Sleepiness Scale, polysomnography, and the Orthostatic Grading Scale (OGS), a questionnaire to assess the degree of autonomic dysfunction. Diabetic patients with OSA and PLMs scored higher on the OGS than controls. Our results confirm that both OSA and PLMs are related to dysautonomy and may be unrelated to obesity in type 2 diabetes patients

Impact of intermolecular drug-copolymer interactions on size and drug release kinetics from pH-responsive polymersomes

pH-sensitive polymersomes are produced from amphiphilic copolymers of the type mPEG-b-(PMMA-ran-PDMAEMA) obtained via ATRP, so that mPEG with molecular masses of 2k and 5kDa forms the corona of a hydrophobic double layer with 22â\u80\u9328% molar content in protonable DMAEMA. Vesicles obtained via dialysis were loaded with curcumin, 2-naphthole, paclitaxel (PTX) and ampicillin sodium salt, and the release kinetics of the latter studied via UV-vis spectrometry as a function of pH. Overall, the release profiles clearly indicated a dopant-sensitive kinetics and, likely, mechanism depending on molecule-copolymer interactions. Infrared spectrometry highlighted the formation of hydrogen bonds and salt bridges that may be responsible for these findings; support for the formation of the latter are obtained comparing the IR spectrum for ampicillin doped-vesicles with the anharmonic vibrational transition of model salt bridges. Importantly, DLS data indicated that our vesicles appeared to remain stable even at pH 4.4 after 48 h and completely releasing ampicillin. The release profiles of co-loaded curcumin/PTX with ampicillin also suggest that desorption rates of water-soluble species can be modulated by the presence of hydrophobic molecules in the double layer, at least at pH 7.4 and 6.4