A Minor Modification of Lichtenstein Repair of Primary Inguinal Hernia: Postoperative Discomfort Evaluation.

The aim of this study was to evaluate the usefulness of a modification of the Lichtenstein hernioplasty procedure by evaluating its impact on postoperative discomfort. From December 1999 to May 2006, the Lichtenstein inguinal hernioplasty was performed in 406 patients with noncomplicated unilateral inguinal hernia. During reconstruction, the mesh was fixed to the inguinal canal floor without stitching its upper margin to the internal oblique muscle. Control of postoperative pain proved to be satisfactory; 72 hours after surgery, 26.1 per cent of patients no longer felt any pain, whereas 54.4 per cent had slight pain without the need for painkillers; on Day 7, 92.8 per cent felt no pain at all. After 10 days, 86.7 per cent of those with sedentary jobs were able to return to work, whereas 79.1 per cent of those with heavier jobs resumed work in 11 to 15 days. Our modification of the original Lichtenstein procedure permitted us to obtain satisfactory results with regard to the control of postoperative chronic pain and a rapid reprisal of normal working activity

Arsenic in Water Resources of the Southern Pampa Plains, Argentina

Confronted with the need for accessible sources of good quality water and in view of the fact that the threat to public health posed by arsenic occurs mainly through the ingestion of contaminated drinking water, the presence and distribution of arsenic was evaluated in the southern Pampa Plains of Bahía Blanca district in Argentina. The findings show variable concentrations of arsenic in a complex distribution pattern. Complementary information is provided on the behavior of the groundwater resource and its salinity in terms of dissolved ions. Groundwater is the most severely affected, 97% of the samples exceeding the guideline value for arsenic in drinking water as recommended by the WHO (Guidelines for Drinking Water Quality, 2004). and showing maximum concentrations of up to 0.30 mg/L. Informing those responsible for preventive medicine and alerting the community at large will facilitate measures to mitigate exposure and ensure the safety of drinking water

Lovastatin induces apoptosis of k-ras-transformed thyroid cells via inhibition of ras farnesylation and by modulating redox state.

Transformation of thyroid cells with either K-ras or H-ras viral oncogenes produces cell types with different phenotype and different response to the inhibition of the prenylation pathway by 3-hydroxy-3-methylglutaryl-CoA reductase or farnesyltransferase inhibitors. These inhibitors induce apoptosis in K-ras-transformed FRTL-5 cells (FRTL-5-K-Ras) whereas cell cycle arrest is induced in H-ras-transformed FRTL-5 (FRTL-5-H-Ras). In FRTL-5-K-Ras cells, the product of K-ras gene is implicated in the scavenging of reactive oxygen species (ROS) through the activation of extracellular-signal-regulated kinase (ERK)1/2 kinases. We observed that lovastatin blocked ras activation through inhibition of farnesylation and induced apoptosis, increasing ROS levels through inhibition of ERK1/2 signaling and Mn-SOD expression. Lovastatin-induced apoptosis was due to intracellular ROS increase since both, the antioxidant compound pyrrolidinedithiocarbamate or the SOD-mimetic compound, antagonized apoptosis. Moreover, both p38 mitogen-activated protein kinase and nuclear factor kappaB pathways, activated as a consequence of high ROS levels, are involved in the apoptotic effect, indicating that cell death induced by lovastatin was dependent on oxidative stress. Lovastatin antitumor efficacy in K-ras-dependent thyroid tumors was further confirmed in vivo, proposing a new therapeutic strategy for those tumor diseases that are sustained by an inappropriate K-ras expression

SECTOR: Secure Common Information Space for the Interoperability of First Responders

AbstractThe ever-growing human, economic and environmental losses due to natural and/or man-made disasters demand a systematic, holistic, inter-governmental and multi-disciplinary approach to the management of large-scale crisis. However, crisis management is usually coordinated by local authorities, supported by a variety of different national and international crisis management organizations, all acting relatively autonomously. Coordination actions usually adopt non-interoperable information management tools, due to the heterogeneity of the involved organizations, limiting or even hindering the coordination efforts. This paper introduces the efforts conducted in the context of the EU-funded project called SECTOR, which aims at establishing the foundations of future Collaborative Crisis Management (CCM) Information Spaces by expanding the European scientific knowledge base on (cross-border) multi-agency processes and their complications when setting-up and designing the enabling information systems

Patients with multiple sclerosis: a burden and cost of illness study

Background Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease negatively impacting patients' physical, psychological and social well-being with a significant economic burden. Objectives The study estimates MS burden and cost of illness in Italy from a societal perspective in 2019. Methods Information on the impact of the disease on daily activities, symptoms, employment, resource utilization and the role of caregivers was collected through questionnaires completed by 944 patients and caregivers. Results were stratified according to both disease severity and payer. Mean costs and overall costs were extrapolated from the sample to the Italian MS population considering published distribution of severity. Results The study showed a great impact of the disease on daily and work activities increasing with the disability. The overwhelming burden of fatigue emerged. Mean annual costs were estimated at euro39,307/patient (euro29,676, euro43,464 and euro53,454 in mild, moderate and severe cases, respectively). Direct healthcare costs were the major component (euro21,069), followed by indirect costs (euro15,004). The overall cost of the disease in Italy was euro4.8 billion. The National Healthcare System (NHS) sustained most of the costs (80%), most notably direct healthcare costs, while patients paid almost all non-healthcare expenses. Conclusions This study confirmed that MS carries a substantial burden to patients and society, highlighting the need for awareness of this disease

Cripta Ardeatina, en Roma

Entre las obras realizadas en Italia después de la guerra, corresponde a la ordenación de la Cripta Ardeatina, en Roma, el primer lugar entre la arquitectura monumental. Creemos poder afirmar que esta obra quedará en la historia del movimiento italiano moderno como una conquista cierta, que ninguna moda podrá alterar

Cost-effectiveness analysis of Vaborem in Carbapenem-resistant Enterobacterales (CRE) - 'Klebsiella pneumoniae' infections in Italy

BackgroundVaborem is a fixed dose combination of vaborbactam and meropenem with potent activity against target Carbapenem-resistant Enterobacterales (CRE) pathogens, optimally developed for Klebsiella pneumoniae carbapenemase (KPC). The study aims to evaluate the cost-effectiveness of Vaborem versus best available therapy (BAT) for the treatment of patients with CRE-KPC associated infections in the Italian setting.MethodsA cost-effectiveness analysis was conducted based on a decision tree model that simulates the clinical pathway followed by physicians treating patients with a confirmed CRE-KPC infection in a 5-year time horizon. The Italian National Health System perspective was adopted with a 3% discount rate. The clinical inputs were mostly sourced from the phase 3, randomised, clinical trial (TANGO II). Unit costs were retrieved from the Italian official drug pricing list and legislation, while patient resource use was validated by a national expert. Model outcomes included life years (LYs) and quality adjusted life years (QALYs) gained, incremental costs, incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). Deterministic and probabilistic sensitivity analyses were also performed.ResultsVaborem is expected to decrease the burden associated with treatment failure and reduce the need for chronic renal replacement therapy while costs related to drug acquisition and long-term care (due to higher survival) may increase. Treatment with Vaborem versus BAT leads to a gain of 0.475 LYs, 0.384 QALYs, and incremental costs of €3549, resulting in an ICER and ICUR of €7473/LY and €9246/QALY, respectively. Sensitivity analyses proved the robustness of the model and also revealed that the probability of Vaborem being cost-effective reaches 90% when willingness to pay is €15,850/QALY.ConclusionsIn the Italian setting, the introduction of Vaborem will lead to a substantial increase in the quality of life together with a minimal cost impact, therefore Vaborem is expected to be a cost-effective strategy compared to BAT

On the dwarf irregular galaxy NGC 6822. I. Young, intermediate and old stellar populations

We present accurate and deep multi-band ($g,r,i$) photometry of the Local Group dwarf irregular galaxy NGC 6822. The images were collected with wide field cameras at 2m/4m- (INT,CTIO,CFHT) and 8m-class telescopes (SUBARU) covering a 2 square degrees FoV across the center of the galaxy. We performed PSF photometry of $\approx$7,000 CCD images and the final catalog includes more than 1 million objects. We developed a new approach to identify candidate field and galaxy stars, and performed a new estimate of the galaxy center by using old stellar tracers finding that it differs by 1.15 (RA) and 1.53 (DEC) arcmin from previous estimates. We also found that young (Main Sequence, Red Supergiants), intermediate (Red Clump, Asymptotic Giant Branch [AGB]) and old (Red Giant Branch [RGB]) stars display different radial distributions. Old stellar population is spherically distributed and extends to radial distances larger than previously estimated ($\sim$1 degree). The young population shows a well defined bar and a disk-like distribution, as suggested by radio measurements, that is off-center compared with old population. We discuss pros and cons of the different diagnostics adopted to identify AGB stars and develop new ones based on optical-NIR-MIR color-color diagrams (CCDs) to characterize Oxygen and Carbon (C) rich stars. We found a mean population ratio between Carbon and M-type (C/M) stars of 0.67$\pm$0.08 (optical/NIR/MIR) and we used the observed C/M ratio with empirical C/M-metallicity relations to estimate a mean iron abundance of [Fe/H]$\sim$-1.25 ($\sigma$=0.04 dex) that agrees quite well with literature estimates.Comment: Accepted for publication in ApJ, 34 pages, 22 figures, 6 table