Nitrogen dioxide pollution increases vulnerability to COVID-19 through altered immune function

Previous ecological studies suggest the existence of possible interplays between the exposure to air pollutants and SARS-CoV-2 infection. Confirmations at individual level, however, are lacking. To explore the relationships between previous exposure to particulate matter < 10 μm (PM₁₀) and nitrogen dioxide (NO₂), the clinical outcome following hospital admittance, and lymphocyte subsets in COVID-19 patients with pneumonia. In 147 geocoded patients, we assessed the individual exposure to PM₁₀ and NO₂ in the 2 weeks before hospital admittance. We divided subjects according to the clinical outcome (i.e., discharge at home vs in-hospital death), and explored the lymphocyte-related immune function as an index possibly affecting individual vulnerability to the infection. As compared with discharged subjects, patients who underwent in-hospital death presented neutrophilia, lymphopenia, lower number of T CD45, CD3, CD4, CD16/56 + CD3 + , and B CD19 + cells, and higher previous exposure to NO₂, but not PM₁₀. Age and previous NO₂ exposure were independent predictors for mortality. NO₂ concentrations were also negatively related with the number of CD45, CD3, and CD4 cells. Previous NO₂ exposure is a co-factor independently affecting the mortality risk in infected individuals, through negative immune effects. Lymphopenia and altered lymphocyte subsets might precede viral infection due to nonmodifiable (i.e., age) and external (i.e., air pollution) factors. Thus, decreasing the burden of air pollutants should be a valuable primary prevention measure to reduce individual susceptibility to SARS-CoV-2 infection and mortality.

Nipple-areola complex reconstruction techniques: A literature review

Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the techniques described until now is not available, a possibly comprehensive literature overview was carried out from 75 papers (years 1946-2015). The local flap was the most frequently described technique for the nipple reconstruction with no significant difference in complications' rate among the various types of techniques. Complications in nipple reconstruction were 46.9% after graft, 7.9% after local flap, and 5.3% in case of flaps with autologous graft/alloplastic/allograft augmentation, while complications in areola reconstruction were 10.1% after graft, and 1.6% after areola tattoo. Flaps appear to be more reliable than grafts in nipple reconstruction, while tattoo is thought to be safer than graft in areola reconstruction. The loss of projection, although considerable (45%-75%), had not significant impact on patients' satisfaction. Due to contraction, overcorrection of 25-50% of the desired result is advisory when adopting local flaps, in order to prevent loss of projection. The use of flaps with autologous graft/alloplastic/allograft augmentation (cartilage, fat, calcium hydroxylapatite, acellular dermal matrix, polymethylmethacrylate, biologic collagen) showed a minor loss of nipple projection but may expose to a relative increased number of postoperative flap necrosis.

Effect of repeated subcutaneous injections of carbon dioxide (CO2) on inflammation linked to hypoxia in adipose tissue graft

OBJECTIVE

The purposes of this study was to assess the effect of repeated subcutaneous injections of CO2 on adipose tissue graft survival in immunosuppressed female nude mice. The authors designed an experimental study using volume measures, histopathological analysis and nuclear magnetic resonance of fat graft. The effect of repeated subcutaneous injection of CO2 is not yet investigated

MATERIALS AND METHODS

Approximately 0.5 ml of human fat were transplanted in a group of female nude mice. The mice were treated with 3 injections of 80 µl each carbon dioxide (total 240 µl) for 7 weeks. Initially, in vivo measurements were conducted and subsequently a comprehensive histopathological analysis was performed.

RESULTS

The presence of inflammation was graded absent to minimal in animals treated with CO2 while a minimal to moderate grade was assigned to the control group.

CONCLUSIONS

CO2 injection enhances the inflammatory response of the implanted tissue and reduces the reabsorption rate. The treatment may improve the graft survival in a more prolonged time-frame.

Urinary JCV-DNA testing during natalizumab treatment may increase accuracy of PML risk stratification

The risk of progressive multifocal leukoencephalopathy (PML) in patients treated with natalizumab for multiple sclerosis (MS) is a serious concern. The presence of anti-JC virus antibodies is a risk factor for PML development, but 2.5 % of the patients result falsely-negative, while the prognostic relevance of testing JCV-DNA in biological fluids of treated patients is debated. Aim of this work was to evaluate the utility of testing JCV-DNA, together with anti-JCV antibodies, in biological samples of treated patients as a tool for PML risk stratification. 126 subjects from 5 MS Centers in Italy were included in the study. We performed a cross-sectional study in 63 patients testing JCV-DNA in blood, peripheral blood cells and urine. We longitudinally assessed the presence of JCV-DNA in a cohort of 33 subjects, one of which developed PML. We could test retrospectively serum samples from another PML case occurred during natalizumab therapy. Anti-JCV antibodies and urinary JCV-DNA were both tested in 73 patients. No changes in JCV-DNA status occurred during natalizumab treatment. The subject who developed PML in the longitudinal cohort had detectable JCV-DNA in urine at all time-points while serum or blood from both PML patients were always negative before the onset of disease and, in one case, after. Four subjects with JCV-DNA in urine and undetectable anti-JCV antibodies were retested for anti-JCV antibodies and three out of four resulted positive. In conclusion, testing JCV-DNA in urine is complementary to testing anti-JCV antibodies in identifying patients at risk of PML.

Management of gynecomastia: an outcome analysis in a multicentric study

AIM

Male gynecomastia (MG), the most frequent mammary anomaly in human males, is a clinical disease occurring mainly in adolescence and old age. The aim of this study was therefore to analyze 126 consecutive cases of mixed gynecomastia, in order to assess the incidence of early and late postoperative complications and to evaluate the aesthetic results and the quality of life after surgery.

METHODS

From January 1st, 2000, to December 31st, 2006 a total of 126 cases of MG were performed by the Plastic Surgery Units of Siena and Pisa. Patients' average age was 28 years, 111 patients (88%) presented bilateral MG, and 15 (11.9%) had monolateral MG. The prevalent surgical approach was adenomammectomy with periareolar inferior or inverted "Omega" incision, other technique included circumareolar or vertical scar incision and liposuction. Before and one year after surgery, all patients were given a questionnaires to evaluate the motivations leading to the request of a treatment ,the degree of satisfaction related to the result and the improvement of the quality of life.

RESULTS

Overall complication rate was 17.72% All patients reported an improvement in their quality of life with an average score of satisfaction of 8.2/10.

CONCLUSION

Patients' degree of satisfaction was high, surgery, in fact, has contributed in all cases to improve their quality of life. On the basis of the short operating time and of the few sequele, we suggest to the patients affected by gynecomastia to undergo surgery always and as soon as possible. A separated analysis of the data obtained by the two University Centres show that they overlap in respect to the sample, the employed technique and results.

[Giant atypical lipoma of the thigh. Case report and literature review]

Lipomas are benign tumors of mesenchymal origin which may localize in various sites, both superficial or deep. Among the benign tumors they have an incidence of around 10%; most of them have small size and low weight (about 30 g); huge masses (giants lipomas) are uncommon. The Authors report the case of a 73 years old woman, with a large swelling localized at the anterior-medial region of the left thigh, of about three years, completely asymptomatic, surgically excised, and by histological examination, proved to be a giant atypical lipoma.

The results of two multicenter, open-label studies assessing efficacy, tolerability and safety of protiramer, a high molecular weight synthetic copolymeric mixture, in patients with relapsing–remitting multiple sclerosis

Objective

Two pilot studies were conducted to evaluate safety, tolerability, and efficacy of two doses of Protiramer (TV-5010) in patients with relapsing–remitting multiple sclerosis.

Background

Both glatiramer acetate and TV-5010 are synthetic copolymers comprised the same four amino acids in a defined molar ratio. TV-5010 has higher average molecular weight than Glatiramer acetate and might be hypothesized that glatiramoids with higher molecular weight might be more immunoreactive than lower molecular weight peptides, thus increasing therapeutic potential and allowing for less frequent dosing.

Methods

In the two separate studies, after a 10 week pretreatment period, TV-5010 was given subcutaneously once weekly at 15 mg and 30 mg for 36 weeks. The primary end point was a reduction in the number of magnetic resonance imaging active lesions (i.e., T1-weigthed gadolinium-enhancing and new T2-weighted lesions) between the pretreatment period and the end of study.

Results

Both TV-5010 doses were generally well tolerated. The treatment with TV-5010 at a dose of 15 mg/wk did not show any significant effect. In contrast, in patients treated with at a dose of 30 mg/wk, a significant reduction in the mean number of gadolinium-enhancing (−58.8%; P = 0.0013) and new T2-W (−50%; P = 0.0002) lesions was observed. However, a large decrease in the mean number of both gadolinium-enhancing (−55%) and new T2-W (−40%) lesions during the pretreatment period made difficult the interpretation of the efficacy assessments.

Conclusions

Further studies are needed to confirm these preliminary data on safety and efficacy of TV-5010 at a weekly dose of 30 mg.

[Solid pseudo papillary tumor of the pancreas: case report and literature review]

Solid pseudopapillary neoplasm (SPT) of the pancreas is a rare exocrine tumor, for the first time described from Frantz et al. in 1959. Despite the increasing recognition of the tumor in this last year, its pathogenesis remain unclear. It occurs predominantly in young woman and behave in an indolent fashion, even when distant metastasis are present. The Authors report the case of a 24 years-old woman with an abdominal mass localized in retro-peritoneum, removed with body-tail of the pancreas and spleen, diagnosed as pancreatic SPT after histological examination.

Mayer-Rokitansky-Küster-Hauser syndrome presenting as vaginal atresia: report of two cases

Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome) is characterized by Müllerian duct structures agenesis: the vagina atresia is the commonest variant. There can be some anomalies associated, such as renal, skeletal, spine malformations and others. Patients with MRKH can show different presentation from newborn period to adolescence. We report our experience in treatment of the vaginal atresia presenting in two young girls as a sign of MRKH syndrome.

[Eosinophilic colitis: an unusual cause of acute abdomen. Case report and review of literature]

The Authors report a case of acute abdomen caused by a colic stenosis due to eosinophilic gastroenteritis. It is a not frequent disease, often clinically unclear: in the medical literature the Authors have found only 346 cases in publications concerning the period January 1990 - December 2005. The clinical presentation is very changeable, related to the involved site of alimentary tract and to the level of eosinophilic infiltration of the wall. There are no diagnosis criteria universally acknowledged and the most efficient procedure is thought being the intestinal biopsy which enables showing the infiltration of the digestive wall. The cure is above all medical with administration of corticosteroid: surgery surely has a less important role, reserved to the cases with acute onset.

Portal dose measurements by a 2D array

A 2D array (PTW, type 10024), equipped with 729 vented plane parallel ion-chambers, has been calibrated as a detector for the in vivo comparison between measured and predicted portal doses for head-neck tumors. The comparison of absolute portal doses measured to ones predicted by a commercial treatment planning system within the field of view of the CT scanner, can help the delivered dose verification during different treatment fractions, in particular when the patient's present weight loss. This paper reports the preliminary results of the comparison of the portal doses measured by a PTW 2D array during several radiotherapy fractions and the predicted portal doses for seven patients undergoing head-neck tumor radiotherapy. The gamma index analysis supplied an agreement of more than 95% of the dose-point P(gamma)>95% within acceptance criteria, in terms of dose difference, DeltaD(max), and distance-agreement, Deltad(max), equal to 5% and 4mm, respectively. After the third week, one patient showed a decrease of P(gamma) values due to the markedly reduced patient's thickness. Even if the spatial resolution of the 2D array was 1cm, there were two advantages in the use of this 2D array as a portal dose device for IMRT quality control. The first one was the use of a stable and efficient absolute dosimeter for in vivo verification, although its construction and behavior for other gantry angles need to be tested, and the second one was the time efficiency in verifying the correct dose delivery in several fractions of the therapy. This study presents acceptance criteria for the comparison of TPS-predicted portal dose images with in vivo 2D ion-chamber measurements for IMRT. In particular, portal dose measurements offer clues for additional studies as to which indicators can signal the need for replanning during treatment.

Comparative characterisation of a commercial human chorionic gonadotrophin extracted from human urine with a commercial recombinant human chorionic gonadotrophin

BACKGROUND

A commercial preparation of recombinant human chorionic gonadotrophin (r-hCG, Ovitrelle) was launched in 2001. Generally, hCG is available in two formats: human chorionic gonadotrophin (u-hCG), derived from the urine of pregnant females, and r-hCG produced by DNA based biotechnology.

METHOD

The analytical characteristics of a highly purified u-hCG (Gonasi HP) were assessed and compared, for the first time, with the recombinant derived r-hCG (Ovitrelle). Gonasi HP is produced by extracting and purifying hCG from urine to obtain a specific bioactivity of 5000 IU/mg protein. Ovitrelle is produced via a recombinant derived mammalian cell line and purified to obtain a specific activity of 26 000 IU/mg.

RESULTS AND CONCLUSION

It has been documented that commercially available u-hCG preparations can contain a number of urine derived protein contaminants as well as hCG related metabolites. This is also the case for Gonasi HP, where hCG related molecules and other proteins were found to be present, including epidermal growth factor (EGF) and eosinophil derived neurotoxin (EDN). It was also demonstrated that this preparation contained high levels of oxidised hCG. r-hCG was confirmed to be essentially intact hCG, free from contaminant proteins and with very low levels of oxidised hCG.

[Surgical management of incidental Meckel's diverticulum: the necessity to obtain the informed consent]

Surgical approach to the incidentally found Meckel's diverticulum (MD) is still source of debate: some support the systematic search and the surgical resection, others suggest to leave in situ the asymptomatic diverticulum. A wide literature review and some claims for malpractice referred to resection of diverticular formations (2 cases are described herein) allow us to deem that the removal of an asymptomatic MD may be an excess of surgical indication regarding an entity that cannot be defined as pathological for itself; anyway, the informed consent must be obtained before the incidental resection. The consent to the removal of MD must always be requested for laparotomies in which the surgeon forecasts the possibility to remove a diverticulum eventually found. Finally, an easy informed consent form about an incidentally found MD to be submitted to the patient is proposed.

Mandibular intrabony lesion as first sign of sarcoidosis: case report

A 33-year-old woman with intra-bony sarcoidosis of the mandible is reported. This presentation of sarcoidosis was the first sign of the disease in this patient, and was treated surgically because of an inaccurate biopsy report. Medical therapy was instituted once the diagnosis was made, and the disease was well controlled (including the mandibular localization) at 2 years follow-up.

Segmental phenolization for the treatment of ingrowing toenails: a review of 6 years experience

BACKGROUND

Ingrowing toenails are a common problem causing significant morbidity. Many of the procedures used for treating this painful condition cause considerable discomfort and have high failure rates. In recent years, phenol cauterization of the nail bed has been used increasingly.

METHODS

A retrospective study was carried out of all patients treated by this method in the authors' clinic during the period January 1996 to December 2001. In this study, phenol cauterization is the standard form of treatment and 948 phenol cauterizations were carried out in 764 patients.

RESULTS

There was no significant morbidity and the procedure was tolerated well by all patients. Overall recurrence was 4.3% (33 patients) after 18 months. All symptomatic recurrences were successfully treated by repeating phenol cauterization.

CONCLUSIONS

Phenol cauterization compares favourably with other surgical ablation techniques for ingrowing toenails and may be the ablation procedure of choice of an ingrowing toenail.

Experimental dosimetry of a 32P catheter-based endovascular brachytherapy source

The experimental dosimetry in a water phantom of a 32P linear source, 20 mm in length, used for the brachytherapy of coronary vessels is reported. The source content activity, A, was determined by means of a calibrated well ion-chamber and the value was compared with the contained activity reported in the manufacturer's certification. In this field of brachytherapy dosimetry, radiochromic film supplies a high enough spatial resolution. A highly sensitive radiochromic film, that presents only one active layer, was used in this work for the source dosimetry in a water phantom. The radiochromic film was characterized by electron beams produced by a clinical linac. A Monte Carlo calculation of beta spectra in water at different distances along the source transverse bisector axis allowed to take into account the low dependence of film response from the electron beam energy. The adopted experimental set-up, with the source in its catheter positioned on the film plane inside the water phantom, supplies accurate dosimetric information. The measured dose rate to water per unit of source activity at reference distance, D(r0, theta0)/A, in units of cGy s(-1) GBq(-1), was in agreement with the value reported in the manufacturer's certification within the experimental uncertainty. The radial dose function, g(r), is in good agreement with the literature data. The anisotropy function F(r, theta) is also reported. The analysis of the dose profile obtained at 2 mm from the source longitudinal axis shows that the uniformity is within 10% along 75% of the 20 mm treatment length. The adopted experimental set-up seems to be adequate for the quality control procedure of the dose homogeneity distribution in the water medium.

Carbon dioxide therapy in the treatment of localized adiposities: clinical study and histopathological correlations

The authors report their experience using carbon dioxide (CO2) therapy for the treatment of 48 female patients presenting adipose accumulations, located on the thighs, knees, and/or abdomen; a Carbomed Programmable Automatic Carbon Dioxide Therapy apparatus was used. In light of the effects of CO2 on the microcirculation recently described in the literature, we expected this gas, which we administered subcutaneously, to positively affect the physiological oxidative lipolytic process. The aim of our study was to evaluate the effect of this therapy on localized adiposities. As such, we describe the method we used and report the results observed in the areas treated (in terms of reduction in maximum circumference) as well as side effects. Furthermore, we assessed the effect of subcutaneous administration of CO2 on the microcirculation by showing changes in the Laser Doppler signal and in the concentration of transcutaneous oxygen tension (tcPO2). Pre- and posttreatment biopsies of tissues were performed in seven patients in order to study the changes induced by the use of CO2 on both adipose and connective tissues. All data obtained were statistically analyzed; values of P < 0.05 were considered significant.

Cutaneous metastasis from small cell lung carcinoma. Case report

We report a rare case of cutaneous metastatic small cell lung carcinoma of the upper lip in a 73-year-old man, which was excised and the defect repaired with a single advancement flap from the cheek. The prognosis of such lesions is poor, and the incidence of other metastases elsewhere is high. The aim of treatment was to give him optimal quality of life for the short time left. The patient died of his primary disease four months later.

Cosmetic results in 242 patients treated by conservative surgery for breast cancer

The surgery of breast cancer has changed lately in favour of breast conserving treatment, the main purpose of which is to provide good cosmetic results together with radical resection of the tumour. In this paper we describe the cosmetic results obtained in 242 patients treated by conservative surgery (226 quadrantectomies, 93%, and 16 lumpectomies, 7%) for low risk breast cancer. Several of these resections were combined with plastic surgical techniques for residual breast reshaping. The technique chosen depended on the site of tumour, width of resection, and breast volume. The cosmetic assessment was made by the patient and the physician. Our data suggest that better cosmetic results may be obtained when plastic surgical procedures are combined with conservative surgery for breast cancer.

Mitochondrial transcription and processing of transcripts during release from glucose repression in 'resting cells' of Saccharomyces cerevisiae

Mitochondrial transcription and processing of transcripts have been investigated at different stages of release from glucose repression in resting cells of Saccharomyces cerevisiae. Transcripts were identified by hybridization with nick-translated or terminally labelled gene-specific probes. This allowed the determination of the steady-state levels of individual transcripts in the mitochondrial RNA population. Results showed different gene-specific patterns of response to respiratory induction: no increase in the level of transcripts (oxi2); a rapid increase in the steady-state levels of all transcripts (cob); a very strong increase in the processing of the high-molecular-mass precursors (oxi3 and oli2); an increase in the level of stable circular transcripts (oxi3). As a whole the results indicate specific and differentiated effects of release from glucose repression on the expression of the different mitochondrial genes and demonstrate the importance of processing events in mitochondrial regulation.

[Cranial acupuncture in the treatment of spasticity. Neurophysiological findings]

On the basis of a study of the innervation of the cutaneous areas stimulated in cranial acupuncture, a neurophysiological classification of the technique is proposed, considering the bulbar level as the first site of integration of the afferent vessels activated by cranial acupuncture.

[Cranial acupuncture in the treatment of spasticity. Clinical results]

Hospitals in communist China perfected a new acupuncture technique about 3 yrs ago, whereby needles are placed in the scalp to stimulate the cortical centres below. This method is particularly indicated in subjects with neurological damage. Results observed in 45 subjects with cerebral vasculopathy at the neurological clinic of Pisa University and the reflexotherapy service of the University of Turin were encouraging and suggest that clinical experimentation should be attempted on a wider scale.