Unilateral giant renal angiomyolipoma and pulmonary lymphangioleiomyomatosis

Angiomyolipomas (AMLs) are mesenchymal neoplasms, named so because of the complex tissue composition represented by variable proportions of mature adipose tissue, smooth muscle cells, and dysmorphic blood vessels. Although AMLs may rise in different sites of the body, they are mostly observed in the kidney and liver. In the case of renal AMLs, they are described in two types: isolated AMLs and AMLs associated with tuberous sclerosis (TS). While most cases of AMLs are found incidentally during imaging examinations and are asymptomatic, others may reach huge proportions causing symptoms. Pulmonary lymphangioleiomyomatosis (LAM) is a rare benign disease characterized by cystic changes in the pulmonary parenchyma and smooth muscle proliferation, leading to a mixed picture of interstitial and obstructive disease. AML and LAM constitute major features of tuberous sclerosis complex (TSC), a multisystem autosomal dominant tumor-suppressor gene complex diagnosis. The authors report the case of a young female patient who presented a huge abdominal tumor, which at computed tomography (CT) show a fat predominance. The tumor displaced the right kidney and remaining abdominal viscera to the left. Chest CT also disclosed pulmonary lesions compatible with lymphangioleiomyomatosis. Because of sudden abdominal pain accompanied by a fall in the hemoglobin level, the patient underwent an urgent laparotomy. The excised tumor was shown to be a giant renal AML with signs of bleeding in its interior. The authors call attention to the diagnosis of AML and the huge proportions that the tumor can reach, as well as for ruling out the TSC diagnosis, once it may impose genetic counseling implications.

A phase I randomized, double-blind, controlled trial of 2009 influenza A (H1N1) inactivated monovalent vaccines with different adjuvant systems

Methods We conducted a phase I, multicenter, randomized, double-blind, placebo-controlled, multi-arm (10) parallel study involving healthy adults to evaluate the safety and immunogenicity of influenza A (H1N1) 2009 non-adjuvanted and adjuvanted candidate vaccines. Subjects received two intramuscular injections of one of the candidate vaccines administered 21 days apart. Antibody responses were measured by means of hemagglutination-inhibition assay before and 21 days after each vaccination. The three co-primary immunogenicity end points were the proportion of seroprotection >70%, seroconversion >40%, and the factor increase in the geometric mean titer >2.5. Results A total of 266 participants were enrolled into the study. No deaths or serious adverse events were reported. The most commonly solicited local and systemic adverse events were injection-site pain and headache, respectively. Only three subjects (1.1%) reported severe injection-site pain. Four 2009 influenza A (H1N1) inactivated monovalent candidate vaccines that met the three requirements to evaluate influenza protection, after a single dose, were identified: 15 μg of hemagglutinin antigen without adjuvant; 7.5 μg of hemagglutinin antigen with aluminum hydroxide, MPL and squalene; 3.75 μg of hemagglutinin antigen with aluminum hydroxide and MPL; and 3.75 μg of hemagglutinin antigen with aluminum hydroxide and squalene. Conclusions Adjuvant systems can be safely used in influenza vaccines, including the adjuvant monophosphoryl lipid A (MPL) derived from Bordetella pertussis with squalene and aluminum hydroxide, MPL with aluminum hydroxide, and squalene and aluminum hydroxide.

Cyclic alternating pattern in sleep and its relationship to creativity

Background/Objectives: Sleep has been shown to enhance creativity, but the reason for this enhancement is not entirely known. There are several different physiological states associated with sleep. In addition to rapid (REM) and non-rapid eye movement (NREM) sleep, NREM sleep can be broken down into Stages (1-4) that are characterized by the degree of EEG slow wave activity. In addition, during NREM sleep there are transient but cyclic alternating patterns (CAP) of EEG activity and these CAPs can also be divided into three subtypes (A1-A3) according to speed of the EEG waves. Differences in CAP ratios have been previously linked to cognitive performances. The purpose of this study was to learn the relationship CAP activity during sleep and creativity. Methods: The participants were 8 healthy young adults (4 women), who underwent 3 consecutive nights of polysomnographic recording and took the Abbreviated Torrance Test for Adults (ATTA) on the 2 and 3rd mornings after the recordings. Results: There were positive correlations between Stage 1 of NREM sleep and some measures of creativity such as fluency (R= .797; p=.029) and flexibility ( R=.43; p=.002), between Stage 4 of Non-REM sleep and originality (R= .779; p=.034) and a global measure of figural creativity (R= .758; p=.040). There was also a negative correlation between REM sleep and originality (R= -.827; p= .042) . During NREM sleep the CAP rate, which in young people is primarily the A1 subtype, also correlated with originality (R= .765; p =.038). Conclusions: NREM sleep is associated with low levels of cortical arousal and low cortical arousal may enhance the ability of people to access to the remote associations that are critical for creative innovations. In addition, A1 CAP activity reflects frontal activity and the frontal lobes are important for divergent thinking, also a critical aspect of creativity.

Studio osservazionale sulle complicanze della fibrillazione atriale nell'area di Bologna.

Premesse: Gli eventi ischemici (EI) e le emorragie cerebrali (EIC) sono le più temute complicanze della fibrillazione atriale (FA) e della profilassi antitrombotica. Metodi: in 6 mesi sono stati valutati prospetticamente i pazienti ammessi in uno dei PS dell’area di Bologna con FA associata ad EI (ictus o embolia periferica) o ad EIC. Risultati: sono stati arruolati 178 pazienti (60 maschi, età mediana 85 anni) con EI. Il trattamento antitrombotico in corso era: a) antagonisti della vitamina K (AVK) in 31 (17.4%), INR all’ingresso: <2 in 16, in range (2.0-3.0) in 13, >3 in 2; b) aspirina (ASA) in 107 (60.1%); c) nessun trattamento in 40 (22.5%), soprattutto in FA di nuova insorgenza. Nei 20 pazienti (8 maschi; età mediana 82) con EIC il trattamento era: a)AVK in 13 (65%), INR in range in 11 pazienti, > 3 in 2, b) ASA in 6 (30%). La maggior parte degli EI (88%) ed EIC (95%) si sono verificati in pazienti con età > 70 anni. Abbiamo valutato l’incidenza annuale di eventi nei soggetti con età > 70 anni seguiti neo centri della terapia anticoagulante (TAO) e nei soggetti con FA stimata non seguiti nei centri TAO. L’incidenza annuale di EI è risultata 12% (95%CI 10.7-13.3) nei pazienti non seguiti nei centri TAO, 0.57% (95% CI 0.42-0.76) nei pazienti dei centri TAO ( RRA 11.4%, RRR 95%, p<0.0001). Per le EIC l’incidenza annuale è risultata 0.63% (95% CI 0.34-1.04) e 0.30% (95% CI 0.19-0.44) nei due gruppi ( RRA di 0.33%/anno, RRR del 52%/anno, p=0.040). Conclusioni: gli EI si sono verificati soprattutto in pazienti anziani in trattamento con ASA o senza trattamento. La metà dei pazienti in AVK avevano un INR sub terapeutico. L’approccio terapeutico negli anziani con FA deve prevedere un’ adeguata gestione della profilassi antitrombotica.

Confronto fra periodizzazione Tradizionale e a Blocchi per l’allenamento della forza in atleti maschi e partecipanti di genere femminile.

La prima parte dello studio riguarda la descrizione dell’origine e delle caratteristiche che differenziano la periodizzazione tradizionale e quella a blocchi per l’allenamento della forza. L’obiettivo della seconda parte del lavoro è stato quello di confrontare gli adattamento ormonali e prestativi ad un programma di allenamento della forza periodizzato secondo il modello tradizionale o secondo quello a blocchi in un campione di atleti di forza. Venticinque atleti maschi sono stati assegnati con procedura randomizzata al gruppo con programmazione tradizionale (TP) o a quello a blocchi (BP). Prelievi di saliva sono stati effettuati prima e dopo 6 diverse sedute di allenamento durante il programma al fine di rilevare i livelli di testosterone (T) e cortisolo (C). Le valutazioni dei parametri antropometrici e prestativi sono state effettuate prima e dopo le 15 settimane di allenamento previste. In nessuno dei due gruppi vi sono state variazioni significative nei livelli ormonali. I risultati indicano che il gruppo BP ha ottenuto incrementi superiori a quello TP riguardo alla forza massima (p = 0,040) ed alla potenza (p = 0,035) espressa alla panca piana. Nella terza parte dello studio, la periodizzazione tradizionale e quella a blocchi sono state confrontate riguardo agli effetti sulla forza massima e sull’ipertrofia in donne allenate di livello amatoriale. Diciassette donne hanno partecipato all’esperimento allenandosi 3 volte a settimana per 10 settimane. I risultati dimostrano che entrambe le periodizzazioni hanno portato a miglioramenti significativi di forza e potenza; il gruppo TP ha tuttavia ottenuto incrementi superiori di forza massima (p = 0,039) e ipertrofia degli arti inferiori (p = 0,004). La periodizzazione tradizionale quindi si è dimostrata più efficace per aumentare la forza massima e la sezione muscolare della coscia in partecipanti di genere femminile. I risultati contrastanti nei due generi potrebbero essere legati a rapporti diversi fra processi anabolici e catabolici.

The oxidation capacity of the atmosphere - OH and HO 2 radical measurements in a boreal forest environment using laser induced fluorescence spectroscopy

Das wichtigste Oxidationsmittel für den Abbau flüchtiger Kohlenwasserstoffverbindungen (VOC, engl.: volatile organic compounds) in der Atmosphäre ist das Hydroxylradikal (OH), welches sich in einem schnellen chemischen Gleichgewicht mit dem Hydroperoxylradical (HO2) befindet. Bisherige Messungen und Modellvergleiche dieser Radikalspezies in Waldgebieten haben signifikante Lücken im Verständnis der zugrundeliegenden Prozesse aufgezeigt.rnIm Rahmen dieser Doktorarbeit wurden Messungen von OH- und HO2-Radikalen mittelsrnlaserinduzierten Fluoreszensmesstechnik (LIF, engl.: laser-induced fluorescence) in einem Nadelwald in Süd-Finnland während der Messkampagne HUMPPA–COPEC–2010 (Hyytiälä United Measurements of Photochemistry and Particles in Air – Comprehensive Organic Precursor Emission and Concentration study) im Sommer 2010 durchgeführt. Unterschiedliche Komponenten des LIF-Instruments wurden verbessert. Eine modifizierte Methode zur Bestimmung des Hintergrundsignals (engl.: InletPreInjector technique) wurde in den Messaufbaurnintegriert und erstmals zur Messung von atmosphärischem OH verwendet. Vergleichsmessungen zweier Instrumente basierend auf unterschiedlichen Methoden zur Messung von OH-Radikalen, chemische Ionisationsmassenspektrometrie (CIMS - engl.: chemical ionization mass spectrometry) und LIF-Technik, zeigten eine gute Übereinstimmung. Die Vergleichsmessungen belegen das Vermögen und die Leistungsfähigkeit des modifizierten LIF-Instruments atmosphärische OH Konzentrationen akkurat zu messen. Nachfolgend wurde das LIF-Instrument auf der obersten Plattform eines 20m hohen Turmes positioniert, um knapp oberhalb der Baumkronen die Radikal-Chemie an der Schnittstelle zwischen Ökosystem und Atmosphäre zu untersuchen. Umfangreiche Messungen - dies beinhaltet Messungen der totalen OH-Reaktivität - wurden durchgeführt und unter Verwendung von Gleichgewichtszustandsberechnungen und einem Boxmodell, in welches die gemessenen Daten als Randbedingungen eingehen, analysiert. Wenn moderate OH-Reaktivitäten(k′(OH)≤ 15 s−1) vorlagen, sind OH-Produktionsraten, die aus gemessenen Konzentrationen von OH-Vorläuferspezies berechnet wurden, konsistent mit Produktionsraten, die unter der Gleichgewichtsannahme von Messungen des totalen OH Verlustes abgeleitet wurden. Die primären photolytischen OH-Quellen tragen mit einem Anteil von bis zu einem Drittel zur Gesamt-OH-Produktion bei. Es wurde gezeigt, dass OH-Rezyklierung unter Bedingungen moderater OH-Reaktivität hauptsächlich durch die Reaktionen von HO2 mit NO oder O3 bestimmt ist. Während Zeiten hoher OH-Reaktivität (k′(OH) > 15 s−1) wurden zusätzliche Rezyklierungspfade, die nicht über die Reaktionen von HO2 mit NO oder O3, sondern direkt OH bilden, aufgezeigt.rnFür Hydroxylradikale stimmen Boxmodell-Simulationen und Messungen gut übereinrn(OHmod/OHobs=1.04±0.16), während HO2-Mischungsverhältnisse in der Simulation signifikant unterschätzt werden (HO2mod/HO2obs=0.3±0.2) und die simulierte OH-Reaktivität nicht mit der gemessenen OH-Reaktivität übereinstimmt. Die gleichzeitige Unterschätzung der HO2-Mischungsverhältnisse und der OH-Reaktivität, während OH-Konzentrationen von der Simulation gut beschrieben werden, legt nahe, dass die fehlende OH-Reaktivität in der Simulation eine noch unberücksichtigte HO2-Quelle darstellt. Zusätzliche, OH-unabhängigernRO2/HO2-Quellen, wie z.B. der thermische Zerfall von herantransportiertem peroxyacetylnitrat (PAN) und die Photolyse von Glyoxal sind indiziert.

Monitoraggio di sorgenti e verifica della potenziale interferenza idrogeologica di una galleria: Il caso della tratta stradale Grosseto-Siena

Questo studio è stato sviluppato attraverso il monitoraggio idrogeologico di sorgenti e piezometri al fine di individuare il rischio di eventuali influenze causate dai lavori di ampliamento a 4 corsie di un tratto della S.S. 223 di Paganico (tratta Grosseto – Siena ) che prevede la costruzione di nuovi tratti di galleria ubicati nell’area. Il tratto di interesse per la presente tesi va dal km 30+040 al km 41+600 della tratta Siena-Grosseto, corrispondente ai lotti 5, 6, 7 e 8. I lavori riguardano i comuni di Monticiano (provincia di Siena) e Civitella Paganico (provincia di Grosseto), lungo la valle del Fiume Merse in un’area ad elevato pregio ambientale presso la confluenza con il Torrente Farma. Le attività di cantiere nel tratto interessato sono iniziate nel Dicembre 2013; si stima che le opere saranno completate per Luglio 2015. Il lavoro di tesi sul campo è stato svolto con il supporto tecnico della società di consulenza geo-ingegneristica di Bologna Studio Mattioli s.r.l. la quale ha ricevuto l’incarico del monitoraggio idrogeologico dal Gruppo Strabag che si occupa di costruzione di grandi infrastrutture. Il lavoro sul campo è consistito in un’attività di monitoraggio idrogeologico, anche tramite sensori in continuo, per più di 1 anno idrologico (novembre 2013- Gennaio 2015), su sorgenti e piezometri captanti acque sia fredde che termali. Il monitoraggio è stato basato sia su un approccio in discontinuo che in continuo. I punti di monitoraggio sono situati presso la località dei Bagni di Petriolo a cavallo tra la provincia di Siena e di Grosseto. I dati relativi alle sorgenti raccolti mensilmente sono la portata ed i parametri fisico-chimici in situ. Per piezometri i dati raccolti mensilmente sono il livello piezometrico ed i medesimi dati fisico-chimici raccolti per le sorgenti. I dati raccolti sono serviti a formulare il modello idrogeologico concettuale del sito ed a valutare le potenzialità d’interferenza idrogeologica delle gallerie sul sistema idrico sotterraneo.

Preservation of Amputated Extremities by Extracorporeal Blood Perfusion; a Feasibility Study in a Porcine Model

Successful extremity transplantations and replantations have to be performed within 6 h of amputation to avoid irreversible tissue loss. This study investigates ex vivo the technical feasibility and the limb preservation potential of extracorporeal whole blood perfusion in a porcine model.

Stroke, coronary and peripheral artery disease survey on antithrombotic treatment (START IT)

QUESTIONS UNDER STUDY: To determine the perception of primary care physicians regarding the risk of subsequent atherothrombotic events in patients with established cardiovascular (CV) disease, and to correlate this perception with documented antithrombotic therapy. METHODS: In a cross-sectional study of the general practice population in Switzerland, 381 primary care physicians screened 127 040 outpatients during 15 consecutive workdays in 2006. Perception of subsequent atherothrombotic events in patients with established CV disease was assessed using a tick box questionnaire allowing choices between low, moderate, high or very high risk. Logistic regression models were used to determine the relationship between risk perception and antithrombotic treatment. RESULTS: Overall, 13 057 patients (10.4%) were identified as having established CV disease and 48.8% of those were estimated to be at high to very high risk for subsequent atherothrombotic events. Estimated higher risk for subsequent atherothrombotic events was associated with a shift from aspirin monotherapy to clopidogrel, vitamin K antagonist or aspirin plus clopidogrel (p <0.001 for trend). Clopidogrel (12.7% vs 6.8%, p <0.001), vitamin K antagonist (24.5% vs 15.6%, p <0.001) or aspirin plus clopidogrel (10.2% vs 4.2%, p <0.001) were prescribed in patients estimated to be at high to very high risk more often than in those at low to moderate risk. CONCLUSIONS: Perception of primary care physicians regarding risk of subsequent atherothrombotic events varies in patients with CV disease, and as a result antithrombotic therapy is altered in patients with anticipated high to very high risk even though robust evidence and clear guidelines are lacking.

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite

INTRODUCTION: The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). METHODS: The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. RESULTS: The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. CONCLUSIONS: MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars.

DensiProbe Spine: a novel instrument for intraoperative measurement of bone density in transpedicular screw fixation

STUDY DESIGN.: Cadaver study. OBJECTIVE.: To determine bone strength in vertebrae by measuring peak breakaway torque or indentation force using custom-made pedicle probes. SUMMARY OF BACKGROUND DATA.: Screw performance in dorsal spinal instrumentation is dependent on bone quality of the vertebral body. To date no intraoperative measuring device to validate bone strength is available. Destructive testing may predict bone strength in transpedicular instrumentations in osteoporotic vertebrae. Insertional torque measurements showed varying results. METHODS.: Ten human cadaveric vertebrae were evaluated for bone mineral density (BMD) measurements by quantitative computed tomography. Peak torque and indentation force of custom-made probes as a measure for mechanical bone strength were assessed via a transpedicular approach. The results were correlated to regional BMD and to biomechanical load testing after pedicle screw implementation. RESULTS.: Both methods generated a positive correlation to failure load of the respective vertebrae. The correlation of peak breakaway torque to failure load was r = 0.959 (P = 0.003), therewith distinctly higher than the correlation of indentation force to failure load, which was r = 0.690 (P = 0.040). In predicting regional BMD, measurement of peak torque also performed better than that of indentation force (r = 0.897 [P = 0.002] vs. r = 0.777 [P = 0.017]). CONCLUSION.: Transpedicular measurement of peak breakaway torque is technically feasible and predicts reliable local bone strength and implant failure for dorsal spinal instrumentations in this experimental setting.

Reactive oxygen species mediate functional differences in human radial and internal thoracic arteries from smokers

Smoking not only increases the risk that coronary heart disease will develop but also morbidity and mortality in patients with known coronary atherosclerosis and after coronary artery bypass grafting. Excessive generation of reactive oxygen species (ROS) has been implicated as the final common pathway for the development of endothelial dysfunction in various cardiovascular risk factors. This study assessed the influence of smoking on two different human arteries routinely used as coronary artery bypass graft conduits.

Intussusceptive microvascular growth in tumors

Intussusception is an alternative to the sprouting mode of angiogenesis. The advantage of this mechanism of vascular growth is that blood vessels are generated more rapidly and the capillaries thereby formed are less leaky. This review article summarizes our current knowledge concerning the role played by intussusceptive microvascular growth in tumor growth. Interestingly, an angiogenic switch from sprouting to intussusceptive angiogenesis occurs after treatment with angiogenesis inhibitors and may be considered as a tumor-protective adaptative response.