Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose–Response Curves in Worsening Refractory Congestive Heart Failure

Introduction: Diuretic responsiveness in patients with chronic heart failure (CHF) is better assessed by urine production per unit diuretic dose than by the absolute urine output or diuretic dose. Diuretic resistance arises over time when the plateau rate of sodium and water excretion is reached prior to optimal fluid elimination and may be overcome when hypertonic saline solution (HSS) is added to high doses of furosemide. Methods: Forty-two consecutively hospitalized patients with refractory CHF were randomized in a 1:1:1 ratio to furosemide doses (125 mg, 250 mg, 500 mg) so that all patients received intravenous furosemide diluted in 150 ml of normal saline (0.9%) in the first step (0–24 h) and the same furosemide dose diluted in 150 ml of HSS (1.4%) in the next step (24–48 h) as to obtain 3 groups as follows: Fourteen patients receiving 125 mg (group 1), fourteen patients receiving 250 mg (group 2), and fourteen patients receiving 500 mg (group 3) of furosemide. Urine samples of all patients were collected at 30, 60, and 90 min, and 3, 4, 5, 6, 8, and 24 h after infusion. Diuresis, sodium excretion, osmolality, and furosemide concentration were evaluated for each urine sample. Results: After randomization, 40 patients completed the study. Two patients, one in group 2 and one in group 3 dropped out. Patients in group 1 (125 mg furosemide) had a mean age of 77 ± 17 years, 43% were male, 6 (43%) had heart failure with a preserved ejection fraction (HFpEF), and 64% were in New York Heart Association (NYHA) class IV; the mean age of patients in group 2 (250 mg furosemide) was 80 ± 8.1 years, 15% were male, 5 (38%) had HFpEF, and 84% were in NYHA class IV; and the mean age of patients in group 3 (500 mg furosemide) was 73 ± 12 years, 54% were male, 6 (46%) had HFpEF, and 69% were in NYHA class IV. HSS added to furosemide increased total urine output, sodium excretion, urinary osmolality, and furosemide urine delivery in all patients and at all time points. The percentage increase was 18,14, and 14% for urine output; 29, 24, and 16% for total sodium excretion; 45, 34, and 20% for urinary osmolarity; and 27, 36, and 32% for total furosemide excretion in groups 1, 2, and 3, respectively. These findings were translated in an improvement in the furosemide dose–response curves in these patients. Conclusion: These results may serve as new pathophysiological basis for HSS use in the treatment of refractory CHF

Clofarabine and Treosulfan as Conditioning for Matched Related and Unrelated Hematopoietic Stem Cell Transplantation: Results from the Clo3o Phase II Trial

ABSTRACT Allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be curative for patients with hematologic malignancies. The ideal conditioning regimen before allo-HSCT has not been established. We conducted a Phase II study to evaluate the tolerability and efficacy of clofarabine and treosulfan as conditioning regimen before allo-HSCT. The primary objective was to evaluate the cumulative incidence of nonrelapse mortality (NRM) on day +100. Forty-four patients (36 with acute myelogenous leukemia, 5 with acute lymphoblastic leukemia, 3 with myelodysplastic syndromes) were enrolled. The median patient age was 47 years, and the median duration of follow-up was 27 months. The conditioning regimen was based on clofarabine 40 mg/m2 (days -6 to -2) and treosulfan 14 g/m2 (days -6 to -4). Allogeneic hematopoietic stem cells were derived from a sibling (n = 22) or a well-matched unrelated donor (n = 22). Graft-versus-host disease (GVHD) prophylaxis consisted of antithymocyte globulin, rituximab, cyclosporine, and a short-course of methotrexate. The regimen allowed for rapid engraftment and a 100-day NRM of 18%, due mainly to bacterial infections. The incidences of grade II-IV acute GVHD and chronic GVHD were 16% and 19%, respectively. The rates of overall survival (OS), progression-free survival, and relapse at 2 years were 51%, 31%, and 50%, respectively. Significantly different outcomes were observed between patients with low-intermediate and patients with high-very high Disease Risk Index (DRI) scores (1-year OS, 78% and 24%, respectively). Our findings show that the use of treosulfan and clofarabine as a conditioning regimen for allo-HSCT is feasible, with a 78% 1-year OS in patients with a low-intermediate DRI score. However, 1-year NRM was 18%, and despite the intensified conditioning regimen, relapse incidence remains a major issue in patients with poor prognostic risk factors

Clinical rating scale for pantothenate kinase-associated neurodegeneration: A pilot study

Pantothenate kinase-associated neurodegeneration is a progressive neurological disorder occurring in both childhood and adulthood. The objective of this study was to design and pilot-test a disease-specific clinical rating scale for the assessment of patients with pantothenate kinase-associated neurodegeneration.info:eu-repo/semantics/publishedVersio

Dry-farming yield of herbaceous crops for energy grown in Mediterranean environment. First results.

Results of a two-year trial carried out in southern Italy to compare the biomass production of different herbaceous crops for energy under rainfed conditions are reported. The compared species were: Cynara cardunculus, Crambe abyssinica, Brassica napus var. oleifera, Brassica carinata, Carthamus tinctorius, Helianthus annuus, Helianthus tuberosus, Arundo donax, Sorghum bicolor var. saccharatum, Sorghum bicolor x S. dochna. Very different rain courses were recorded in the two years. In the first year, B. carinata, B. napus, C. tinctorius, C. abyssinica produced 1.3, 1.0, 1.1 and 1.3 t ha-1 of seed respectively, while in the second year such values raised to 2.4, 2.1, 1.8 and 1.9 t ha-1. C. cardunculus showed the higher yield of 20.6 t ha-1 d.m. in the second year. Also H. annuus, H tuberosus, S. bicolor saccharatum and S. bicolor x S. dochna showed higher productions in the second year, with values of 1.4, 4.2, 16.4 and 19.5 t ha-1 respectively for seed, dry tubers and dry biomass. A. donax reached 9.2 t ha-1 d.m. at the first harvesting, in the second year

Assessing endocrine and immune parameters in human immunodeficiency virus-infected patients before and after the immune reconstitution inflammatory syndrome

ABSTRACT Objective The present study compares immune and endocrine parameters between HIV-infected patients who underwent the Immune Reconstitution Inflammatory Syndrome (IRIS-P) during antiretroviral therapy (ART) and HIV-patients who did not undergo the syndrome (non-IRIS-P). Materials and methods Blood samples were obtained from 31 HIV-infected patients (15 IRIS-P and 16 non-IRIS-P) before ART (BT) and 48 ± 2 weeks after treatment initiation (AT). Plasma Interleukin-6 (IL-6) and Interleukin-18 (IL-18) were determined by ELISA. Cortisol, dehydroepiandrosterone sulfate (DHEA-S) and thyroxin concentrations were measured using chemiluminescence immune methods. Results Concentrations of IL-6 (7.9 ± 1.9 pg/mL) and IL-18 (951.5 ± 233.0 pg/mL) were significantly higher (p 0.05). Levels of DHEA-S in IRIS-P decreased AT (1080.5 ± 124.2 vs. 782.5 ± 123.8 ng/mL, p < 0.05) and they were significantly lower than in non-IRIS-P (782.5 ± 123.8 vs. 1203.7 ± 144.0 ng/mL, p < 0.05). IRIS-P showed higher values of IL-6 and IL-18 BT and lower levels of DHEA-S AT than in non-IRIS-P. Conclusion These parameters could contribute to differentiate IRIS-P from non-IRIS-P. The significant decrease in DHEA-S levels in IRIS-P after ART might suggest a different adrenal response in these patients, which may reflect the severity of the disease

Role of nephron sparing surgery in the treatment of centrally located renal tumors.

OBJECTIVES: In recent years many long-term data have suggested that nephron sparing surgery can be considered as an effective method of treatment also in patients with small, solitary, unilateral renal cell carcinoma and a normal contralateral kidney. Generally, partial nephrectomy is performed for peripheral tumors and usually is limited to imperative indication for central tumors to avoid hemodialysis. We retrospectively evaluate the value of tumor location on technical and oncological results, particularly in patients with elective indication. PATIENTS AND METHODS: Between 1993 and 2002, 112 patients underwent nephron sparing surgery at our institution. The tumor was centrally and peripherally located in 22 and in 90 cases, respectively. The tumor was discovered in 13 (56%) central and in 57 (63%) peripheral tumors incidentally. The indication was imperative in 12 and elective in 10 patients for central group, while it was imperative in 34 and elective in 56 patients for peripheral group. RESULTS: The mean renal ischemia time was longer in central group compared to peripheral group (20.81 versus 18.8 minutes p&lt;0.05) and the collecting system was violated more frequently in central group (53% versus 28% p&lt;0.05). Postoperative complications were higher for central tumors compared to peripheral tumors (18% versus 4% p&lt;0.05) but the ultimate mean serum creatinine level was similar for central and peripheral tumors (1.36 versus 1.22 mg/dl). The mean tumor size was 39.69 mm in central group and 32.77 mm in peripheral group (p&lt;0.05). The mean diameter of central tumors in imperative indication was 42 mm while in elective indication was 32 mm (p&lt;0.05). Pathological tumor stage was T1 to T3 in 18 (82%), 1 (4%) and 3 (14%) cases in central group and in 81 (88%), 6 (7%) and 5 (5%) cases in peripheral group. Grades was 1 to 3 in 4 (18%), 15 (68%) and 3 (14%) cases in central group and in 21 (23%), 61 (66%) and 10 (11%) cases in peripheral group. There was no difference in 5-year cancer specific survival (91% versus 98%) or postoperative local tumor recurrences (9% versus 6%) in central tumors compared to peripheral tumors and there was no local recurrence in elective partial nephrectomy performed in central tumors. CONCLUSIONS: Nephron sparing surgery is technically more demanding in patients with central tumors. However there were no significant differences in cancer specific survival and local recurrence between centrally versus peripherally located tumors. Elective partial nephrectomy can be performed also in patients with central tumors as long as really less than 4 cm

Undifferentiated Pleomorphic Sarcoma and the Importance of Considering the Oncogenic and Immune-Suppressant Role of the Human T-Cell Lymphotropic Virus Type 1: A Case Report

Introduction: Soft-tissue sarcomas account for 0.7 % of all malignant tumors, with an incidence rate of 3 per 100,000 persons/year. The Undifferentiated Pleomorphic Sarcoma (UPS) with giant cells, a high grade tumor of soft tissue, is very unusual, especially in young adults before the age of 40. Human T-cell lymphotropic virus type-1 (HTLV-1) is a human retrovirus, classified as group 1 human carcinogens by The International Agency for Research on Cancer (IARC), that causes an aggressive malignancy known as adult T-cell lymphoma/leukemia (ATLL) and a progressive chronic inflammatory neurological disease named HTLV-1 associated myelopathy/ tropical spastic paraparesis (HAM/TSP). HTLV-1 causes accumulation of genetic mutations in the host genome that could contribute to cellular transformation, one of the oncogenic features of HTLV-1.Case report: We describe a case of a young woman with UPS who suffered from HAM/TSP with 3 years of evolution. In 2013, the patient started with neurological symptoms: weakness in the legs and bladder dysfunction. One year later, the patient developed a mild paraparesis in both extremities, anti-HTLV-1 antibodies were detected in plasma and in cerebrospinal fluid (CSF), and HAM/TSP was confirmed. In November 2015, a benign ganglion cyst was firstly suspected without intervention and by March 2016 a sarcoma was diagnosed. Three weeks after surgical resection, the tumor aroused in deep tissue and behaved aggressively, implicating a curative wide resection of the fibula, joint reconstruction and soft tissue graft. Histopathological examination confirmed UPS with giant cells.Concluding remarks: The unapparent subclinical immunodeficiency state due to HTLV-1 infection deserves to be considered in order to carefully monitor the possibility of developing any type of cancer. Besides, reaching an accurate and timely diagnosis of UPS can be challenging due to the difficulty in diagnosis/classification and delayed consultation. In this particularly case, considering the high grade of UPS and the progressive invalidating myelopathy caused by HTLV-1, treatment should be carefully evaluated to positively impact on the patient´s life expectancy.Fil: Lupo, Sergio. Universidad Nacional de Rosario; ArgentinaFil: Berini, Carolina Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Cánepa, Camila. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Santini Araujo, Eduardo Héctor. Laboratorio de Patología Ortopédica; ArgentinaFil: Biglione, Mirna Marcela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentin

Anisotropy-graded magnetic media obtained by ion irradiation of L10 FePt

We show that Ar+ irradiation can be used effectively to transform a chemically ordered FePt L10 homogeneous thin film into an anisotropy-graded composite media with tunable magnetic response. This can be exploited to produce magnetic media with high thermal stability and moderate coercivity with potential in high-density magnetic recording applications. The depth distribution of the chemical order parameter, which controls the magnetic switching mechanism of the system, has been determined by high-resolution transmission electron microscopy. The irradiation-induced modifications of the material have been modeled using Monte Carlo simulations for ion transport in solids. The magnetic properties and coupling regimes of the resulting exchange-coupled systems are discussed

Effect of the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia

Background: This study sought to evaluate the effect of basic fibroblast growth factor eye drops and cysteine oral supplements on corneal healing in patients treated with photorefractive keratectomy (PRK). Materials and Methods: One hundred and twenty patients treated bilaterally with PRK for myopia were enrolled at one of two eye centers (Clinica Santa Lucia, Bologna, Italy and Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy) and were treated at the former center. Sixty patients included in the study group (Group 1) were treated postoperatively with topical basic fibroblast growth factor plus oral L-cysteine supplements, whereas 60 subjects included in the control group (Group 2) received basic fibroblast growth factor eye drops. We recorded the rate of corneal re-epithelialization and patients were followed-up every 30 days for 6 months. Statistical analyses were performed on the collected data. Results: The eyes in Group 1 demonstrated complete re-epithelialization at Day 5, whereas the eyes in Group 2 achieved this status on Day 6. No side-effects were reported. Conclusions : Patients treated with basic fibroblast growth factor eye drops and L-cysteine oral supplements benefit from more rapid corneal re-epithelialization. In human eyes, this combination treatment appeared to be safe and effective in accelerating corneal surfacing after surgery. Financial Disclosure: No author has any financial or proprietary interest in any material or method used in this study. Trial Registration: Current Controlled Trials ISRCTN73824458. © 2005 - Indian Journal of Ophthalmology

Encephalitis associated with Anti-n-methyl-d-aspartate receptor antibodies. Case report

La encefalitis por anticuerpos contra el receptor N—metil—D— aspartato (NMDA) es una patología neurológica autoinmune reconocida recientemente en el año 2007 que afecta principalmente a adultos jóvenes, predominantemente mujeres y niños. Un gran porcentaje está asociado a procesos tumorales. Clínicamente los pacientes desarrollan de manera rápida y secuencial síntomas neuropsiquiátricos, crisis convulsivas que progresan hacia un rápido deterioro del nivel de consciencia, mutismo, catatonía y movimientos anormales. Es una patología potencialmente reversible y el grado de secuelas va a depender de la rapidez en el inicio del tratamiento. Se presenta el caso de un paciente joven que debutó con conductas autoagresivas y alucinaciones. Cursó posteriormente con trastornos de memoria y lenguaje, alteraciones conductuales y convulsiones y presentó anticuerpos contra receptores NMDA en el líquido cefalorraquídeo (LCR). Realizó tratamiento con inmunoglobulinas y corticoides con evolución favorable logrando control y no progreso de la enfermedad.Encephalitis associated with anti—N—methyl—D—aspartate (NMDA) receptor antibodies is an autoimmune neurological condition recently recognized in 2007. It mainly affects young adults—especially women—and children. A large percentage is associated with tumour processes. Patients develop neuropsychiatric symptoms in a rapid and sequential way and they have convulsive crises that rapidly result in decreasing levels of consciousness, mutism, catatonia and abnormal movements. It is a potentially reversible condition and the seriousness of its effects will depend on how soon the patient receives treatment