Fire in the Operating Room During Hypospadias Repair

Fire in the operating room (OR) is a very distressful and shocking occurrence with potential dramatic consequences. Despite safety rules and rigorous recommendations, such unintentional events do occur every so often. Notably, the vast majority of cases have been reported in the adult population, with very few pediatric cases described to date. Herein, we report on a 16-month-old boy undergoing reconstructive surgery for penoscrotal hypospadias, who experienced an OR fire most likely related to the use of alcohol-based solution ignited by monopolar electrocautery

Modulation of human corticospinal excitability by paired associative stimulation in patients with amyotrophic lateral sclerosis and effects of Riluzole

BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that causes an impairment in both the upper and lower motor neurons. The recent description of numerous non-motor signs points to an involvement of the neocortex networks that is more complex than was previously believed. Paired associative stimulation (PAS), a combination of transcranial magnetic stimulation (TMS) and peripheral nerve stimulation, can enhance motor output in the contralateral hand through an NMDA-mediated sensorimotor mechanism. OBJECTIVE To describe the effects of PAS on ALS patients before and after Riluzole intake compared with healthy subjects. METHODS PAS was used to detect differences between 24 newly-diagnosed ALS patients and 25 age-matched healthy controls. MEP amplitude from the abductor pollicis brevis was considered before PAS, immediately after (T0) and after 10 (T10), 20 (T20), 30 (T30) and 60 (T60) minutes. Statistical significance was calculated using RM-ANOVA. RESULTS In healthy controls, PAS significantly increased MEP amplitude at T10, T20 and T30 (p < 0.05). In ALS patients, a significant increase in MEP amplitude was also observed after 60 min (p < 0.05), thus demonstrating NMDA-mediated enhanced facilitatory plasticity. After two weeks of riluzole intake, no MEP amplitude increase was evident after PAS at any time point. In three monomelic-onset ALS patients, sensorimotor facilitation was evident only in the hemisphere corresponding to the affected side and appeared in the opposite hemisphere when the patients manifested contralateral symptoms. CONCLUSIONS PAS may be considered a useful tool when investigating NMDA-mediated neocortical networks in ALS patients and the modulation of such networks after anti-glutamatergic drug intake

Extra-abdominal cryptorchidism associated with gastroschisis and impacted urethral calculus: two uncommon urologic conditions in one patient

The testis is rarely encountered within the organs prolapsed outside the abdominal wall defect of patients with gastroschisis. Optimal treatment strategy of this unusual type of cryptorchidism remains undefined, with less than 30 cases reported to date. We describe a new case where simple relocation of the testis into the abdomen was followed by spontaneous testicular descent. Additionally, he developed a urinary calculus impacted in the navicular fossa 4 years later. Given the rarity of the 2 conditions, the probability of their co-occurrence is exceptionally rare, especially considering that they seem to be causally and temporally unrelated to one another

Feasibility, safety and outcome of inguinal hernia repair under spinal versus general anesthesia in preterm and term infants

Background: Inguinal hernia repair (IHR) is a common operation in preterm and term infants. Recently, spinal anesthesia (SA) has been proposed as an alternative to avoid exposure to general anesthesia (GA) during early life. The aim of this study was to compare surgical outcomes of open IHR performed under SA versus GA in neonates and infants, and to detect criteria to predict the success or failure of SA. Materials and methods: This is a 6-year, single center, nonrandomized interventional study (2013–2019). SA was performed with 0.5% bupivacaine. GA was given using propofol, fentanyl, sevoflurane, and laryngeal mask. Patient demographics, operative time, intraoperative events related to surgery or anesthesia, and complications were analyzed at short and long-term follow-up. Results: 68 infants (78 IHR) and 37 infants (44 IHR) received SA and GA at the discretion of the anesthesiologist, respectively. SA failure rate was 9%, and positively correlated with weight at surgery (p = 0.001; rp = 0.38). Conversion from SA to GA occurred in 4 (6%) patients owing to prolonged operative time (43.75 ± 4.8 vs 23.02 ± 11.3 min; p = 0.0006). There were no differences regarding operative time and intra- and postoperative complications among the two groups at mean follow-up of 18.53 ± 21.9 months. Conclusions: This pilot study confirms that SA is safe, effective and not detrimental to surgical outcome of neonates and infants undergoing IHR. Additionally, it may help further define what patients may have a successful SA. Our experience suggests that SA is especially suitable in infants weighing &lt; 4000 g, and conversion to GA correlates with prolonged operative time. Level of evidence: Level II

Valori etici e principio di maggioranza

Raramente i temi eticamente sensibili (quali la vita, la morte, l'eutanasia, testamento biologico) trovano spazio nei classici recinti del diritto costituzionale e solo da qualche anno appaiono qua e là introdotti da dichiarazioni internazionali o da caute decisioni della Corte europea dei diritti e di altre Corti internazionali. Non infrequente è l’assunzione di questi temi nell’ambito del diritto costituzionale attraverso un’attività interpretativa evolutiva delle vigenti norme costituzional

Evaluation of Major Minerals and Trace Elements in Wild and Domesticated Edible Herbs Traditionally Used in the Mediterranean Area

The human diet is characterized by the intake of major minerals (Na, K, Ca, Mg, P, N) and trace elements (Zn, Mn, Se, Cu, Fe, Co, I, Cr, F, Pb, Cd) for their key role in many metabolic functions. Nowadays, the research of sources able to improve their intake is in continuous evolution, especially in the undeveloped countries. In this sense, wild edible herbs, commonly used since ancient times, can represent a good alternative to improve the daily human intake of minerals. In this study, four wild edible species, Rumex acetosa, Picris hieracioides, Cichorium intybus, and Plantago coronopus, were analyzed for their content in Na, K, Ca, Mg, Cu, Mn, Fe, and Zn and, besides, three domestications (named “soilless,” pot, and open field) were evaluated in the analyzed species in the prospective of their commercialization as valuable sources of minerals in the human diet. Nitrate and oxalate contents were also evaluated, given their negative impact on human health. Results unveil that open field domestication allowed the plants to maintain the content of major minerals similar to those measured in wild plants, especially in C. intybus and P. hieracioides. The trace elements Cu, Mn, Fe, and Zn were not recorded at high content irrespectively to the wild collection or domestications. Finally, plants grown in the open field also accounted for a high oxalate and nitrate content, especially in R. acetosa. Further researches should be aimed at decreasing the oxalate and nitrate content in the domesticated species and to promote the commercialization of the domesticated species

Reading a GEM with a VLSI pixel ASIC used as a direct charge collecting anode

In MicroPattern Gas Detectors (MPGD) when the pixel size is below 100 micron and the number of pixels is large (above 1000) it is virtually impossible to use the conventional PCB read-out approach to bring the signal charge from the individual pixel to the external electronics chain. For this reason a custom CMOS array of 2101 active pixels with 80 micron pitch, directly used as the charge collecting anode of a GEM amplifying structure, has been developed and built. Each charge collecting pad, hexagonally shaped, realized using the top metal layer of a deep submicron VLSI technology is individually connected to a full electronics chain (pre-amplifier, shaping-amplifier, sample and hold, multiplexer) which is built immediately below it by using the remaining five active layers. The GEM and the drift electrode window are assembled directly over the chip so the ASIC itself becomes the pixelized anode of a MicroPattern Gas Detector. With this approach, for the first time, gas detectors have reached the level of integration and resolution typical of solid state pixel detectors. Results from the first tests of this new read-out concept are presented. An Astronomical X-Ray Polarimetry application is also discussed.Comment: 11 pages, 14 figures, presented at the Xth Vienna Conference on Instrumentation (Vienna, February 16-21 2004). For a higher resolution paper contact [email protected]

Glutamate-mediated blood-brain barrier opening. implications for neuroprotection and drug delivery

The blood-brain barrier is a highly selective anatomical and functional interface allowing a unique environment for neuro-glia networks. Blood-brain barrier dysfunction is common in most brain disorders and is associated with disease course and delayed complications. However, the mechanisms underlying blood-brain barrier opening are poorly understood. Here we demonstrate the role of the neurotransmitter glutamate in modulating early barrier permeability in vivo Using intravital microscopy, we show that recurrent seizures and the associated excessive glutamate release lead to increased vascular permeability in the rat cerebral cortex, through activation of NMDA receptors. NMDA receptor antagonists reduce barrier permeability in the peri-ischemic brain, whereas neuronal activation using high-intensity magnetic stimulation increases barrier permeability and facilitates drug delivery. Finally, we conducted a double-blind clinical trial in patients with malignant glial tumors, using contrast-enhanced magnetic resonance imaging to quantitatively assess blood-brain barrier permeability. We demonstrate the safety of stimulation that efficiently increased blood-brain barrier permeability in 10 of 15 patients with malignant glial tumors. We suggest a novel mechanism for the bidirectional modulation of brain vascular permeability toward increased drug delivery and prevention of delayed complications in brain disorders. SIGNIFICANCE STATEMENT: In this study, we reveal a new mechanism that governs blood-brain barrier (BBB) function in the rat cerebral cortex, and, by using the discovered mechanism, we demonstrate bidirectional control over brain endothelial permeability. Obviously, the clinical potential of manipulating BBB permeability for neuroprotection and drug delivery is immense, as we show in preclinical and proof-of-concept clinical studies. This study addresses an unmet need to induce transient BBB opening for drug delivery in patients with malignant brain tumors and effectively facilitate BBB closure in neurological disorders

Comparison of three domestications and wild-harvested plants for nutraceutical properties and sensory profiles in five wild edible herbs: Is domestication possible?

In this study, five wild edible herbs traditionally consumed in the Tuscany region (Italy) were evaluated for their potential in human nutrition. The nutraceutical characterization of Rumex acetosa, Cichorium intybus, Picris hieracioides, Sanguisorba minor, and Plantago coronopus, as well as their sensory profile were reported. Additionally, a preliminary assessment of completely different domestication of the wild species (named "soilless", pot, and open field) was conducted to verify the possibility of their marketability, which is impossible if the plants are only gathered as wild. The open field domestication allowed to obtain plants with nutraceutical and sensory profiles similar to those of the wild species, especially in C. intybus, P. hieracioides, and S. minor. The pot domestication allow to obtain plants with chlorophyll and carotenoid contents close to those of the wild species, as well as a lower total phenolic and flavonoid content and ascorbic acid content than wild species. In the "soilless"method, R. acetosa and P. coronopus exhibited a high quality in terms of phytochemicals and antioxidant activity. Afterward, the sensory profile was strongly affected by the domestication in terms of the palatability, except for R. acetosa and P. coronopus, which displayed Hedonic Index (HI) values close to the consumer acceptability limit (HI = 6). A sensory profile similar to that of wild species was reported in open field domestication, whereas a worse sensory profile was reported in P. hieracioides and C. intybus domesticated using the soilless method. Finally, according to the preliminary assessment carried out in this study through an analysis of the general nutraceutical properties, S. minor was shown to be the most promising species thanks to its intrinsically highest nutraceutical properties considering the marketability of wild edible herbs as "new"functional food. However, further research on the bioavailability and bioactivity tests of nutraceutical compounds present in this species are required to confirm the findings of this study

Effect of drying methods on phenolic compounds and antioxidant activity of Urtica dioica L. leaves

Stinging nettle (Urtica dioica) is a plant well known in traditional medicine for its many beneficial properties, but the lack of standardization regarding the product to offer to consumers limits its diffusion. To this end, drying appears to be a useful technique to offer a low-cost product that can be stored for long time, but the different drying procedures may give rise to end-products of very different quality as nutraceutical and antioxidant compounds. Nettle leaves have been dehydrated employing freeze-drying (FD), oven-drying (OD) or heat pump drying (HPD) and compared with fresh leaves following water extraction to emulate the use by final consumers. Results indicate that the best dehydration technique is HPD, which apparently gives rise to more than a doubling of total phenols and antioxidant activity in the extract compared to the water extract obtained from fresh leaves but a reduction in the level of ascorbic acid of about 39%. In addition, the content of some phenolic compounds is 10 to over a hundred times higher in the extract after HPD than that obtained from fresh samples. This confirms that the dehydration technique should be tuned in relation to the compounds of greatest interest or value