Wharton’s jelly absence: a possible cause of stillbirth

The umbilical cord is a structure that provides vascular flow between the fetus and the placenta. It contains two arteries and one vein, which are surrounded and supported by gelatinous tissue known as Wharton’s jelly. There are many umbilical cord abnormalities that are related to the prognosis of fetus survival and birth weight. The authors report a case of umbilical cord constriction due to the localized absence of Wharton’s jelly, which was undiagnosed antenatally and had a fatal outcome. A review of the association between the absence of Wharton’s jelly and an unfavorable pregnancy outcome was undertaken.

Indagine sulle cause del ritardo nello sviluppo della distribuzione assicurativa in Italia in ottica comparata

L’attività assicurativa svolge un ruolo cruciale nell’economia moderna: riduce le inefficienze di mercato, rendendo possibile per la c.d. economia reale il trasferimento di rischi il cui impatto potrebbe essere devastante qualora l’evento assicurato si verificasse. Questa funzione può naturalmente essere svolta anche in assenza di un canale distributivo indipendente, ma con un significativo aumento dei costi di transazione dovuti, in particolare, a un alto impatto dell’asimmetria informativa per i c.d. rischi non standardizzabili (c.d. commercial lines o business insurance). Tale funzione è tanto più importante nei c.d. cicli di hard market, in cui l’appetito per il rischio delle imprese assicuratrici diminuisce, il prezzo delle coperture aumenta e per le imprese diventa arduo trovare eque coperture sul mercato d’offerta. Lo studio evidenzia che gli intermediari indipendenti italiani non differiscono molto da quelli di altri Paesi per composizione di portafoglio, propensione all’intermediazione di rischi afferenti al segmento Aziende e capacità di selezionare con attenzione i rischi. Nel loro complesso, intermediari indipendenti e in esclusiva sembrano ancorati a modelli e logiche di sviluppo poco orientate al futuro, quali ad esempio poco significative politiche di costruzione di reti secondarie al loro interno. Questo orientamento impedisce a molti di loro di crescere. Le cause ostative alla diffusione del plurimandato sono i costi di transazione e i timori di ritorsione della mandante principale. Dato che l’acquisizione di ulteriori mandati dipende dal numero di clienti in portafoglio in termini di policy sarebbe opportuno, da un lato, riconoscere agli intermediari l’importanza degli investimenti in reti secondarie e, dall’altro, rimuovere tutte gli ostacoli (prevalentemente di natura regolamentare) che impediscono un’ulteriore riduzione dei costi di transazione.

Lo spreco alimentare domestico in Italia: stime, cause ed impatti

Non esiste una definizione standard di spreco alimentare, così come non esistono metodologie uniformi per calcolarlo. Gli studi finora realizzati sullo spreco sono carenti, i dati raccolti spesso insufficienti. Il cibo viene sprecato ad ogni stadio della filiera alimentare, dal campo alla tavola. Nei Paesi Membri dell’Unione Europea, le famiglie – secondo dati elaborati da Eurostat- sono le principali responsabili dello spreco. Secondo la FAO, ogni europeo spreca ogni anno 179 chili di alimenti. Last Minute Market, spin off accademico che si occupa di ridurre e recuperare lo spreco, ha stimato che a livello domestico in Italia si sprecano mediamente il 17% dei prodotti ortofrutticoli acquistati, il 15% di pesce, il 28% di pasta e pane, il 29% di uova, il 30% di carne e il 32% di latticini. Da un punto di vista economico, lo sperpero alimentare significa una perdita di 1.693 euro l’anno per famiglia. Per inquadrare lo spreco alimentare domestico in Italia e gettare luce su dati contrastanti emersi da diversi studi finora realizzati, la tesi – dopo aver presentato stime a livello globale, europeo e italiano – si concentra sull’analisi dei dati emersi da un questionario sullo spreco domestico, compilato da 3.087 italiani tra il mese di novembre e quello di dicembre 2012. L’indagine socio-economica è stata realizzata in collaborazione con la Commissione Europea (DG JCR, Istituto per la Tutela della Salute dei Consumatori) e il Karlsruhe Institut für Technologie. Il questionario è stato posto sulla piattaforma online surveymonkey. La tesi ha avuto come obiettivi l’identificazione di dati quantitativi circa “quanto si spreca” , “cosa si spreca”, l’individuazione delle cause sociali, valoriali, comportamentali e di stile di vita, dello spreco alimentare delle famiglie italiane, l’impatto economico dello spreco sul budget domestico e l’elaborazione di profili di consumatori attraverso la cluster analysis.

An uncommon cause of coronary artery ostial obstruction: papillary fibroelastoma

Cardiac papillary fibroelastoma is a benign tumor that mainly affects cardiac valves. The tumor has the potential to cause angina and myocardial infarction due to embolization of tumor fragments. We describe a rare case of right coronary artery ostial obstruction by a 12 x 19 mm sized papillary fibroelastoma located in the sinus of Valsalva. The report underlies the importance of echocardiography in diagnosis and intraoperative treatment of this type of cardiac mass.

An unusual cause of hemoptysis--aberrant origin of the left pulmonary artery from the ascending aorta in the adult

Aberrant origin of a pulmonary artery from the ascending aorta is an uncommon congenital vascular malformation with poor survival without surgery. In this case report, we describe the unusual late diagnosis of this congenital malformation in an otherwise asymptomatic young man presenting with mild hemoptysis. We review the natural and modified history of this defect and the relevant aspects of follow-up in adult life.

Intra-arterial injection of neural stem cells using a microneedle technique does not cause microembolic strokes

Intra-arterial (IA) injection represents an experimental avenue for minimally invasive delivery of stem cells to the injured brain. It has however been reported that IA injection of stem cells carries the risk of reduction in cerebral blood flow (CBF) and microstrokes. Here we evaluate the safety of IA neural progenitor cell (NPC) delivery to the brain. Cerebral blood flow of rats was monitored during IA injection of single cell suspensions of NPCs after stroke. Animals received 1 × 10(6) NPCs either injected via a microneedle (microneedle group) into the patent common carotid artery (CCA) or via a catheter into the proximally ligated CCA (catheter group). Controls included saline-only injections and cell injections into non-stroked sham animals. Cerebral blood flow in the microneedle group remained at baseline, whereas in the catheter group a persistent (15 minutes) decrease to 78% of baseline occurred (P<0.001). In non-stroked controls, NPCs injected via the catheter method resulted in higher levels of Iba-1-positive inflammatory cells (P=0.003), higher numbers of degenerating neurons as seen in Fluoro-Jade C staining (P<0.0001) and ischemic changes on diffusion weighted imaging. With an appropriate technique, reduction in CBF and microstrokes do not occur with IA transplantation of NPCs.

All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study

Objective To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip. Design Population based cohort study. Setting General practices in the southwest of England. Participants 1163 patients aged 35 years or over with symptoms and radiological confirmation of osteoarthritis of the knee or hip. Main outcome measures Age and sex standardised mortality ratios and multivariable hazard ratios of death after a median of 14 years’ follow-up. Results Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70). Excess mortality was observed for all disease specific causes of death but was particularly pronounced for cardiovascular (standardised mortality ratio 1.71, 1.49 to 1.98) and dementia associated mortality (1.99, 1.22 to 3.25). Mortality increased with increasing age (P for trend <0.001), male sex (adjusted hazard ratio 1.59, 1.30 to 1.96), self reported history of diabetes (1.95, 1.31 to 2.90), cancer (2.28, 1.50 to 3.47), cardiovascular disease (1.38, 1.12 to 1.71), and walking disability (1.48, 1.17 to 1.86). However, little evidence existed for increased mortality associated with previous joint replacement, obesity, depression, chronic inflammatory disease, eye disease, or presence of pain at baseline. The more severe the walking disability, the higher was the risk of death (P for trend <0.001). Conclusion Patients with osteoarthritis are at higher risk of death compared with the general population. History of diabetes, cancer, or cardiovascular disease and the presence of walking disability are major risk factors. Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity.

Experimental acute type B aortic dissection: different sites of primary entry tears cause different ways of propagation

Many dissections seem to also have a retrograde component. The aim of the study was to evaluate different sites of primary entry tears and the propagation of the dissecting membrane, antegrade and retrograde, in an experimental model of acute type B aortic dissection.

Unique paleopathology in a pre-Columbian mummy remnant from Southern Peru--severe cervical rotation trauma with subluxation of the axis as cause of death

We describe the multidisciplinary findings in a pre-Columbian mummy head from Southern Peru (Cahuachi, Nazca civilisation, radiocarbon dating between 120 and 750 AD) of a mature male individual (40-60 years) with the first two vertebrae attached in pathological position. Accordingly, the atlanto-axial transition (C1/C2) was significantly rotated and dislocated at 38° angle associated with a bulging brownish mass that considerably reduced the spinal canal by circa 60%. Using surface microscopy, endoscopy, high-resolution multi-slice computer tomography, paleohistology and immunohistochemistry, we identified an extensive epidural hematoma of the upper cervical spinal canal-extending into the skull cavity-obviously due to a rupture of the left vertebral artery at its transition between atlas and skull base. There were no signs of fractures of the skull or vertebrae. Histological and immunohistochemical examinations clearly identified dura, brain residues and densely packed corpuscular elements that proved to represent fresh epidural hematoma. Subsequent biochemical analysis provided no evidence for pre-mortal cocaine consumption. Stable isotope analysis, however, revealed significant and repeated changes in the nutrition during his last 9 months, suggesting high mobility. Finally, the significant narrowing of the rotational atlanto-axial dislocation and the epidural hematoma probably caused compression of the spinal cord and the medulla oblongata with subsequent respiratory arrest. In conclusion, we suggest that the man died within a short period of time (probably few minutes) in an upright position with the head rotated rapidly to the right side. In paleopathologic literature, trauma to the upper cervical spine has as yet only very rarely been described, and dislocation of the vertebral bodies has not been presented.

Death by biscuit--exhumation, post-mortem CT, and revision of the cause of death one year after interment

We describe a case of exhumation, performed to investigate the circumstances and cause of death, one year after burial. Post mortem computed tomography (PMCT) revealed a mass in the pharynx. Imaging directed the subsequent forensic autopsy to careful retrieval of a foreign body. Histological analysis revealed a non-cellular composition. The detection of foreign material in the pharynx and its composition indicated accidental, rather than natural death, secondary to choking on food. This unusual case illustrates how post mortem imaging can significantly contribute to forensic investigation and stresses the importance of interdisciplinary collaboration between forensic pathologists and radiologists.

The effects of cause of death classification on prognostic assessment of patients with pulmonary embolism

Although previous studies have provided evidence that the majority of deaths following an acute pulmonary embolism (PE) directly relate to the PE, more recent registries and cohort studies suggest otherwise.