Effect of high level of bladder filling on spinal nociception and motoneuronal excitability

To verify whether high level of bladder distension may counteract the inhibitory effect of descending pathways on sacral spinal cord neurons and to investigate which spinal circuitries are possibly involved in such a viscero-somatic interaction. Nociceptive withdrawal reflex (NWR), cutaneous silent period (CSP), and H-reflex were recorded in both lower and upper limbs of twenty-eight healthy subjects. Subjects were examined during baseline (empty bladder, no voiding desire), high level of bladder filling (urgency desire), and control (empty bladder, no voiding desire) sessions. Results showed that the NWR and its related pain perception were reduced in the upper limbs, while only a pain perception reduction in males was observed in the lower limbs. The H-reflex was inhibited in both limbs. No effects were found on the CSP duration. The decrease in both the NWR and its related pain perception in the upper limbs confirms the presence of a bladder distension-induced descending inhibitory modulation on nociception at spinal level. The lack of a similar inhibitory effect in the lower limbs suggests that excitatory nociceptive inputs from bladder afferents counterbalance the inhibitory effect on sacral spinal cord. The lack of the descending inhibitory effect may be a mechanism aimed at forcing the micturition phase to avoid bladder damage caused by bladder sovradistension

Anesthesiological considerations in shoulder surgery

In 1970, Winnie proposed the brachial plexus block as an alternative and effective anaesthesia technique for shoulder surgery. From that date, several techniques have been developed to approach the brachial plexus: the use of a nerve stimulator and, more recently, the ultrasound guided nerve blockade have made the procedure easier and more effective; the availability of the new drugs demonstrates some major advantages due to the application of peripheral blocks. Nowadays the attention has been focused on postoperative pain control: although many techniques have been proposed, the application of a continuous infusion of local anaesthetics through an interscalene catheter seems the best available technique to achieve pain relief after shoulder surgery. Advantages ad disadvantages of regional anaesthesia and adverse events associated with interscalene brachial plexus blockade are reviewed

Intravenous infusion of magnesium sulphate during subarachnoid anaesthesia in hip surgery and its effect on postoperative analgesia: our experience

The treatment of degenerative hip joint disease involves modern operative techniques and the use of prosthetic devices individualized on each patient. Being a surgery of considerable importance, great attention is always given by the anaesthesiologist to postoperative analgesia. In general, our goal is to limit the doses of NSAIDs, known to be associated with haemostasis interference and alteration of gastrointestinal apparatus; component of our baseline analgesic protocols after arthroplasty is morphine given parenterally. In order to steadily improve analgesic techniques, which directly impact on patient outcome, we experimented the use of a continuous infusion of magnesium sulphate during subarachnoid anaesthesia. Magnesium sulphate is the drug of choice in case of eclampsia, and pre-eclampsia (for the risk of evolution in eclampsia). According to the most recent findings, this drug has also analgesic properties: its use as an adjunct to analgesia is based on a non-competitive antagonism towards the NMDA receptor and on the blocking of calcium channels: these properties prevent the mechanisms of central sensitization due to nociceptive stimulation of peripheral nerves

One-Handed Rotational Phacoemulsification Technique

Introduction: We described a one-handed rotational phacoemulsification technique to decrease phaco time and power, and surgical stress on the cornea in eyes with different types of cataract. Methods: In this technique a single sutureless corneal incision was made without any side-port incision. After hydrodissection and hydrodelamination were performed, a phaco tip was positioned in contact with the nucleus beside the capsulorhexis edge. By using a peristaltic pump, phacoemulsification was started with high levels of vacuum to keep the probe tip on the edge of the lens and to ensure the rotation of the nucleus, and with low ultrasound energy. The torsional mode used required less occlusion time and volume of fluid. The inclination of the tip was modified to 45-degree, directing it toward the lens center. So the nucleus was aspirated from the periphery toward the center by a rotational movement. Results: The eye in the technical video had a NC4-NO4 cataract. The preoperative vision in this eye was 20/100 with no improvement with refraction. On postoperative day 1, visual acuity had improved to 20/20. We recorded low intraoperative parameters including ultrasound time (21.4 sec), phacoemulsification power (73%), balanced salt solution used (31 mL) and cumulative dissipated energy (7.27) at the conclusion of the case. After 1 month, Central Corneal Thickness changed from 504 µm to 516 µm, and Endothelial Cell Loss was 1.15%. Conclusion: This technique uses a single clear corneal incision, high vacuum and low ultrasound power to reduce the exposition to excessive surgical maneuvers, fluid turbulence and ultrasound energy

A new classification and clinical predictivity for some naevus variants

Background. The incidence of cutaneous melanoma is rapidly increasing in Europe. Active research is directed toward the identification of naevi as a risk factor. Objective. The aim of our case-control study was to observe different numbers of moles and different mole typology associations in order to evaluate clinical predictivity and to establish a new classification for some naevus variants. Methods. A case-control study was carried out, enrolling 64 cases affected by melanoma and 183 controls, between October 2009 and February 2011. Each patient was interviewed and subjected to clinical examination. The resulting data were analysed using the statistical elaboration program SPSS 16.0. Results. The association of target naevus with other variants increases the degree of risk (target + small brown Odds Ratio 5.25; confidence interval 1.8-15.4); (target + small brown + small black + large brown odds ratio 5.0; confidence interval 1.1-22.4). Therefore, other variants and/or other variant combinations do not significantly increase risk. Conclusion. People presenting two naevus variants in association with other naevus variants seem to run a major risk. The general nonuniformity of the whole naevus panorama should be carefully considered

Contribution of vitamin D3 and thiols status to the outcome of COVID-19 disease in Italian pediatric and adult patients

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), was declared a global pandemic by the World Health Organization (WHO) on March 2020, causing unprecedented disease with million deaths across the globe, mostly adults. Indeed, children accounted for only a few percent of cases. Italy was the first Western country struck by the COVID-19 epidemic. Increasing age, which is one of the principal risk factors for COVID-19 mortality, is associated with declined glutathione (GSH) levels. Over the last decade, several studies demonstrated that both vitamin D (VD) and GSH have immunomodulatory properties. To verify the association between VD, GSH and the outcome of COVID-19 disease, we conducted a multicenter retrospective study in 35 children and 128 adult patients with COVID-19. Our study demonstrated a hypovitaminosis D in COVID-19 patients, suggesting a possible role of low VD status in increasing the risk of COVID-19 infection and subsequent hospitalization. In addition, we find a thiol disturbance with a GSH depletion associated to the disease severity. In children, who fortunately survived, both VD and GSH levels at admission were higher than in adults, suggesting that lower VD and thiols levels upon admission may be a modifiable risk factor for adverse outcomes and mortality in hospitalized patients with COVID-19

Nutrition in preschool children and later risk of obesity: a systematic review and meta analysis

Objectives and study: Nutrition in infants and preschool children has been suggested to influence the risk of later obesity. However, the evidence for this association is conflicting and few studies have investigated this prospectively or considered the role of energy and specific macronutrients. Here we report a systematic review and meta-analyis of studies that tested the hypothesis that nutrition in the preschool period, between the ages of 6 months and 3 years, is associated with later obesity risk. Methods: MEDLINE, EMBASE and CENTRAL databases were searched from January 1988 to June 2015 for studies reporting nutritional intake in infants and preschool children aged 6-36 months and later measures of obesity. Bibliographies of included studies were hand searched and authors and other experts consulted to identify omissions. We included all studies that investigated dietary energy and/or macronutrient intake during 6-36 months in relation to later measures of obesity. Methodological quality was assessed using the Downs and Black checklist designed specifically to appraise both randomised and non-randomised studies. The checklist was adapted to include aspects of particular relevance to studies investigating nutritional exposures. Two reviewers independently scored studies against the 28 item checklist which included questions on study reporting, external validity, internal validity (bias and confounding), and statistical power. A statistician independently scored questions relating to statistical methods and their decision was final. Data from studies amenable to meta-analysis were analysed using STATA (StataCrop 12, Texas). For continuous outcomes, results were expressed as standardised mean difference (SMD) between the high and low protein intake groups. For dichotomous outcomes, results for each study were expressed as relative risk (RR). Both dichotomous and continuous outcomes were presented with 95% confidence intervals (CI). Between-study heterogeneity was assessed by the Q and I2 statistics. Results: 24 eligible articles (comprising 16 primary studies) were included in a narrative synthesis, and 13 studies in a random-effects meta-analysis. A higher protein intake was associated with later risk of obesity in 15 studies. In 13 studies included in the meta-analysis protein in the preschool period was associated with higher BMI z-score later in childhood (pooled effect size: 0.28 z-scores, 95% CI 0.20 to 0.35)(Figure 1). There was no significant hererogeneity between studies (I2 0.0%, p = 0.932). Associations of energy, fat and carbohydrate were inconclusive. Conclusion: Our findings suggest that nutrition and particularly high protein intake in infants and preschool children is important for risk of later obesity. Although further experimental data are required to establish causality, these findings suggest that optimising the protein intake of these children could be important for their long term health

Sudden Unexpected Deaths and Vaccinations during the First Two Years of Life in Italy: A Case Series Study

Background The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy. Methodology/Principal Findings The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999–2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1–23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0–1, 0–7, and 0–14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0–7 and 0–14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined. Conclusions The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age

Cardiovascular Implications in Idiopathic and Syndromic Obesity in Childhood: An Update

Childhood obesity is a modern worldwide epidemic with significant burden for health. It is a chronic metabolic disorder associated with multiple cardiovascular risk factors such as dyslipidemia, hypertension, stroke, and insulin resistance. Many obese adolescents remain obese into adulthood, with increased morbidity and mortality. As childhood obesity is a risk factor for adult obesity, the childhood obesity-related disorders account for an increased risk of cardiovascular consequences in adults, in addition to the effects already exerted by the fat mass in adulthood. Several papers have already described the cardiovascular implications of idiopathic obesity, while few data are available about syndromic obesity, due to the small sample size, not homogeneous phenotypes, and younger age at death. The aim of this mini-review is to give a comprehensive overview on knowledge about cardiovascular implications of idiopathic and syndromic obesity to allow the reader a quick comparison between them. The similarities and differences will be highlighted.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Characterization of Monilinia spp. Populations on Stone Fruits in South Italy

Monilinia spp. are responsible for brown rot decay of stone and pome fruit in the field as well as in postharvest. Monilinia laxa and M. fructigena are considered indigenous to Europe, while M. fructicola is a quarantine pathogen in the European and Mediterranean Plant Protection Organization area included in the A2 List. In Italy, it was first reported in 2009 in Piedmont (northern Italy) and rapidly spread to central Italy. We carried out a monitoring program on the occurrence of Monilinia spp. in southern Italy and a comparative characterization of the three main fungal pathogens. Molecular assays based on direct polymerase chain reaction (PCR) and real-time quantitative PCR for molecular identification of Monilinia spp. from rotted fruit were set up, validated, and applied in a monitoring program. Of the tested 519 isolates from 26 orchards, 388 (74.8%) were identified as M. fructicola, 118 (22.7%) as M. laxa, 10 (1.9%) as M. fructigena, and 3 (0.6%) were M. polystroma. M. fructicola colonies grew faster and had a higher optimal temperature for growth (26°C) than M. laxa (23°C) and M. fructigena (20°C). No relevant difference in virulence could be observed on artificially inoculated apricot, cherry, and peach fruit. The fungal species showed different responses to fungicides, because M. fructicola was more sensitive than M. laxa, especially to cyflufenamid, and M. fructigena revealed a lower sensitivity to succinate dehydrogenase inhibitors (boscalid, fluopyram, and fluxapyroxad) and quinone outside inhibitors (mandestrobin). In summary, the two species M. fructicola and M. polystroma were first detected in southern Italy where M. fructicola has largely displaced the two indigenous pathogens M. laxa and M. fructigena; the relative proportions of the three pathogens in orchards should be considered when defining the management of brown rot of stone fruit due to differences in their responses to fungicides