Managing benign tracheal stenosis during COVID-19 outbreak

If elective surgery has been recommended to be postponed some diseases could potentially become life-threatening and cannot be delayed. Among these conditions, tracheal idiopathic stenosis, primary caused by endotracheal intubation or tracheostomy, usually become symptomatic when reach 50% obstruction. Endoscopic procedures could be considered as frst treatment in selected patients after stenosis evaluation, such as non-complex stenosis with low grade of cartilage involvement or tracheomalaci

Embryonic and foetal mortality in buffalo species.

The aim of this study was to verify the incidence of late embryonic mortality (between 25 and 45 days post-insemination; LEM) and foetal mortality (between 45 and 70 days postinsemination; FM) in buffaloes synchronized and mated by AI during the transitional period. The trial was performed on 288 multiparous Mediterranean Buffaloes, synchronized and inseminated by AI. Trans-rectal ultrasonography was performed 25, 45, and 70 days post-insemination to assess embryonic development. Milk samples were collected on Days 10, 20, 25, 30, and 45 post-insemination to determine progesterone concentration in whey. Pregnancy rate on Day 25 after AI was 48.6% but declined to 35.4% and to 30.6% by Day 45 and 70 respectively, representing a LEM of 27.1% and a FM of 13.7%. Progesterone concentration was higher (P<0.01) in pregnant compared to LEM buffaloes after 20 days post-insemination. Differences (P<0.05) were found between FM and LEM buffaloes on Days 25 and 30. Furthermore, progesterone concentration in pregnant buffaloes was higher (P=0.09) than that of FM buffaloes on Day 30 and 45. In conclusion, the success of application of reproductive biotechnologies in the transitional period depends from the incidence of embryonic and foetal mortality

Metabolic profile in growing buffalo heifers fed diet with different energy content

Aim of this study was to verify the relation among the mediators and indicators of nutritional status like insulin, glucagon, urea, cholesterol, triglycerides and total proteins in growing buffalo heifers, fed diets with different energy density. 12 Murrah heifers were randomly allocated into two dietary treatments (High, Group H; Low, Group L) that differed in energetic levels (Group H: 5.8 UFL/d; Group L: 3.6 UFL/d). Every 30 days, for a total of five times, blood samples were collected at 08.00 h, before feeding, from the jugular vein in vacutainer tubes and analysed to determine metabolic profile. Data on haematic constants were analysed by ANOVA for repeated measures with treatment as the main factor. Low energy availability and low NSC reduced the glucose and insulin and increased glucagone and urea blood levels. The increase of NSC in the diet of group H during the experiment may caused a reduction of the fibre digestibility after the period of adaptation of the rumen microflora and, as a paradox effect, suffered for an energetic lack with a subsequent activation of lipolysis and mobilization of their body reserves. Liver and muscular synthesis increase in group with a high energy availability

Serologic diagnosis of celiac disease: May it be suitable for adults?

The diagnosis of coeliac disease (CD) in adult patients requires the simultaneous assessment of clinical presentation, serology, and typical histological picture of villous atrophy. However, several years ago, the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines approved new criteria for the diagnosis in children: Biopsy could be avoided when anti-transglutaminase antibody (TGA) values exceed the cut-off of × 10 upper limit of normal (ULN) and anti-endomysium antibodies are positive, independently from value. This “no biopsy” approach is a decisive need for pediatric population, allowing to avoid stressful endoscopic procedures in children, if unnecessary. This approach relies on the correlation existing in children between TGA levels and assessment of mucosal atrophy according to Marsh’s classification. Several lines of evidence have shown that patients with villous atrophy have markedly elevated TGA levels. Therefore, we aim to perform a narrative review on the topic in adults. Despite that some studies confirmed that the × 10 ULN threshold value has a very good diagnostic performance, several lines of evidence in adults suggest that TGA cut off should be different from that of pediatric population for reaching a good correlation with histological picture. In conclusion, the heterogeneity of study reports as well as some conditions, which may hamper the serological diagnosis of CD (such as seronegative CD and non-celiac villous atrophy) and are much more common in adults than in children, could represent a limitation for the “no biopsy” approach to CD diagnosis in patients outside the pediatric age

The influence of propofol, remifentanil and lidocaine on the tone of human bronchial smooth muscle.

Bronchoscopy is generally a safe procedure, but the induction of anaesthesia can induce bronchospasm. Consequently we investigated the influence of propofol, remifentanil and lidocaine on the tone of the human bronchial smooth muscle. Materials and methods: The influence of propofol, remifentanil and lidocaine on the contractile response of human bronchial smooth muscle to electrical field stimulation (EFS) has been evaluated. The role of capsaicin-sensitive sensory nerves and of inducible nitric oxide synthase has also been assessed. Furthermore, the interaction between these three dugs has been measured by Bliss Independence (BI) theory. Statistical significance (P < 0.05) was assessed by Student's t test or ANOVA. Results: Propofol (1.3 μg ml-1) and lidocaine (1 mg ml-1) reduced the baseline tone of bronchial rings (-14.45 ± 4.53% and -33.40 ± 1.07%, respectively, P < 0.05), whereas remifentanil had not such effect. Aminoguanidine prevented the relaxant effect of propofol. Propofol did not alter the bronchial contractile response to EFS following 30 min of treatment, whereas remifentanil enhanced the bronchial tension (133.83 ± 9.38%, control 101.93 ± 6.82%, P < 0.05 P < 0.05) and lidocaine completely abolished the contractility at 1 mg ml-1 (P < 0.05). The desensitization of capsaicin-sensitive sensory nerves normalized the hyperresponsiveness induced by remifentanil (-26.77 ± 1.68%, P < 0.05). Significant BI antagonism (P < 0.001) was detected for propofol and lidocaine on the bronchial hyperresponsiveness induced by remifentanil. Conclusion: Propofol and remifentanil may be used safely for bronchoscopy, although remifentanil should be associated with propofol or lidocaine to prevent the potential opioid-mediated bronchospasm

A Comprehensive System For The Evaluation Of Innovative Online Instruction At A Research University: Foundations, Components, And Effectiveness

The delivery of post-secondary coursework via the Internet continues to gain momentum.&nbsp; As a result, investigations into effective and appropriate methods of evaluating the effectiveness of these courses are required.&nbsp; In an effort to meet this challenge, this study describes the development and implementation of an evaluation system applied to new online programs at a major research university. A systematic approach to evaluation provided formative feedback on the processes and products of course development using diverse data sources including course documents, interviews and web-based surveys.&nbsp; Results of both quantitative and qualitative analyses support the integrity of the evaluation system and provide preliminary indications of course effectiveness based on student satisfaction

Feasibility and safety of the airway bypass procedure for patients with emphysema

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Update on the pathogenesis and genetics of Paget's disease of bone

Studies over the past two decades have led to major advances in the pathogenesis of Paget's disease of bone (PDB) and particularly on the role of genetic factors. Germline mutations of different genes have been identified, as a possible cause of this disorder, and most of the underlying pathways are implicated in the regulation of osteoclast differentiation and function, whereas other are involved in cell autophagy mechanisms. In particular, about 30 different germline mutations of the Sequestosome 1 gene (SQSTM1) have been described in a significant proportion of familial and sporadic PDB cases. The majority of SQSTM1 mutations affect the ubiquitin-binding domain of the protein and are associated to a more severe clinical expression of the disease. Also, germline mutations in the ZNF687 and PFN1 genes have been associated to severe, early onset, polyostotic PDB with increased susceptibly to neoplastic degeneration, particularly giant cell tumor. Mutations in the VCP (Valosin Containing Protein) gene cause the autosomal dominant syndrome "Inclusion Body Myopathy, PDB, Fronto-temporal Dementia," characterized by pagetic manifestations, associated with myopathy, amyotrophic lateral sclerosis and fronto-temporal dementia. Moreover, germline mutations in the TNFRSF11A gene, which encodes for RANK, were associated with rare syndromes showing some histopathological, radiological, and clinical overlap with PDB and in two cases of early onset PDB-like disease. Likewise, genome wide association studies performed in unrelated PDB cases identified other potential predisposition genes and/or susceptibility loci. Thus, it is likely that polygenic factors are involved in the PDB pathogenesis in many individuals and that modifying genes may contribute in refining the clinical phenotype. Moreover, the contribution of somatic mutations of SQSTM1 gene and/or epigenetic mechanisms in the pathogenesis of skeletal pagetic abnormalities and eventually neoplastic degeneration, cannot be excluded. Indeed, clinical and experimental observations indicate that genetic susceptibility might not be a sufficient condition for the clinical development of PDB without the concomitant intervention of viral infection, in primis paramixoviruses, and/or other environmental factors (e.g., pesticides, heavy metals or tobacco exposure), at least in a subset of cases. This review summarizes the most important advances that have been made in the field of cellular and molecular biology PDB over the past decades. © 2022 Gennari, Rendina, Merlotti, Cavati, Mingiano, Cosso, Materozzi, Pirrotta, Abate, Calabrese and Falchetti