The meaning of CPR in the life-world of hospital: perspectives of patients who witnessed CPR and healthcare professionals

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Resuscitation Council (UK)

Background

Cardiopulmonary resuscitation (CPR) in hospital is a stressful experience for patients who witness it and for the healthcare professionals involved. Limited evidence and guidance exist regarding the experience of witnessing a fellow patient’s CPR. Informed by a systematic review [1] and a multi-stakeholder consultation [2], the WATCH (Witnessing an Attempt of CPR in Hospital) study has explored the lived experiences of hospital patients and healthcare professionals on patient-witnessed CPR with the primary aim of understanding the impact of such an experience [3].

Purpose

The purpose of this study was to understand the meaning of CPR in the context of the hospital life-world of patients who witness CPR and of healthcare professionals.

Methods

The WATCH study used a qualitative descriptive phenomenological design. The lived experiences of 16 witnessing patients admitted to nine clinical wards and of 20 healthcare professionals involved in CPR were explored through in-depth interviews and focus groups conducted in one hospital in the UK.

Results

Three themes were developed from analysis indicating that, despite a shared understanding of CPR as part of hospital life and as a potential result of emergencies, patients and healthcare professionals had different perspectives of hospital CPR. 1) Unfamiliarity vs Exposure: although patients were aware of CPR, witnessing CPR was often unexpected and traumatic, as many had not experienced it before. Instead, healthcare professionals with previous knowledge and expertise, held an emotional distance and focused on the clinical tasks of CPR. 2) Fiction vs Reality: healthcare professionals considered patients to have unrealistic expectations of CPR, often uninformed and influenced by distorted portrayal of CPR to the lay public through television. Patients acknowledged that witnessing hospital CPR helped their understanding of the reality of it, which differed from their initial idea. 3) Life vs Death: Patients felt disturbed by the presence of a dead body in their room after CPR, whilst daily activities of hospital life were carried out, highlighting a contrast between life and death in the same environment. Finally, healthcare professionals reflected on the meaning of performing CPR as a process to help the ones witnessing it to face and accept the reality of death.

Conclusion

The WATCH study highlighted that patients and healthcare professionals hold different perspectives of CPR in hospital. Awareness of different perspectives of hospital CPR will help healthcare professionals initiate CPR conversations with hospital patients. Education and accurate information should be offered to hospital patients around CPR to have realistic expectations. Further work is required to guide and support clinical practice around patient-witnessed CPR in hospital.

Prehabilitation and heart failure: main outcomes in the COVID-19 era

OBJECTIVE

The advent of the SARS-CoV-2 pandemic has resulted in an increase in sedentary behavior, with consequences on cardiopulmonary capacity, especially in the elderly population. Prehabilitation is a strategy usually used before a surgical procedure to improve functional capacity; however, it can be used for non-surgical patients and not in the acute phase of disease. The purpose of this study is to evaluate the effectiveness of a prehabilitation program, using telerehabilitation, in frail elderly patients with chronic heart failure.

PATIENTS AND METHODS

This is a randomized, controlled, single-blind study. Fifteen patients with chronic heart failure were randomized into three groups: two active groups (telerehabilitation and in-person) and the control group. Patients in the active groups underwent a rehabilitation program divided into two 4-week periods, for 45-60 minutes per day, 2 days per week.

RESULTS

In the Study Group, the quality of life significantly improved (EQoL-5D), and between the two groups a statistically significant difference in the motor dimension of SF-36 was identified.

CONCLUSIONS

The telerehabilitation prehabilitation program for patients with chronic heart failure was confirmed to be effective and not inferior to a prehabilitation program performed in-person, avoiding the worsening of some domains of quality of life and motor performance, and leading to the improvement of others.

The Quality of Five Natural, Historical Italian Cheeses Produced in Different Months: Gross Composition, Fat-Soluble Vitamins, Fatty Acids, Total Phenols, Antioxidant Capacity, and Health Index

Simple Summary

For the purposes of raising awareness of five historical cheeses of Southern Italy that are less known by consumers, and of restoring dignity to the breeders and producers of these cheeses, we studied their quality in terms of chemical composition, monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), conjugated linoleic acid (CLA), PUFA-ω6, PUFA-ω3, α-tocopherol, retinol, cholesterol, polyphenol content (TPC), total antioxidant capacity (FRAP and TEAC), and health index (GHIC). Two stretched-curd bovine cheeses, Caciocavallo Palermitano (CP) and Casizolu del Montiferru (CdM), two ovine cheeses, Vastedda della Valle del Belìce (VVB) and Pecorino Siciliano (PS), and one caprine cheese, Caprino Nicastrese (CN), were evaluated. These cheeses are produced in different months, with raw milk from animals reared in an extensive feeding system. In April, the CP cheese showed high values for CLA, TPC, and GHIC, while the CN cheese exhibited high PUFA, PUFA-ω6, PUFA-ω3, TEAC, and GHIC. In May, the CdM cheese exhibited high content of fat, saturated fatty acids, PUFA-ω3, α-tocopherol, TEAC, and GHIC, while the PS cheese showed high values of protein, CLA, PUFA, PUFA-ω3, α-tocopherol, and GHIC. These measured parameters characterize and distinguish each cheese due to links with numerous factors: species, breed, feeding system, pasture biodiversity, climate, production technology, traditional tools, and ripening type. It is highlighted that, in general, the highest nutritional quality, linked to the highest presence of healthy compounds, originates from the pasture of cheese production in the spring.

Abstract

Five natural historic cheeses of Southern Italy were investigated—Caciocavallo Palermitano (CP), Casizolu del Montiferru (CdM), Vastedda della Valle del Belìce (VVB), Pecorino Siciliano (PS), and Caprino Nicastrese (CN)—which are produced with raw milk and with traditional techniques and tools, from autochthonous breeds reared under an extensive system. The effects of the month of production on gross composition, MUFA, PUFA, PUFA-ω6, PUFA-ω3, α-tocopherol, retinol, cholesterol, TPC, TEAC, and GHIC were evaluated. In CP, CLA, TPC, and GHIC were higher in April than in February. CdM showed higher values in terms of fat, saturated fatty acids, PUFA-ω3, α-tocopherol, TEAC, and GHIC in May than in February and September, while low values in terms of protein, moisture, and CLA were found. In VVB, MUFA, PUFA-ω6, and α-tocopherol increased in June compared with April; conversely, protein, FRAP, and TEAC were higher in April. In PS, protein, CLA, PUFA, PUFA-ω3, α-tocopherol, and GHIC increased in May compared with January; on the contrary, moisture, NaCl, and TEAC showed high values in January. CN showed higher values in terms of PUFA, PUFA-ω6, PUFA-ω3, TPC, TEAC, and GHIC in April and June compared with January. It is shown that each cheese is unique and closely linked to the production area. Cheeses produced in the spring months showed a high nutritional quality due to the greatest presence of healthy compounds originating from an extensive feeding system.

Isolation and Identification of Bacteria with Surface and Antibacterial Activity from the Gut of Mediterranean Grey Mullets

Fish gut represents a peculiar ecological niche where bacteria can transit and reside to play vital roles by producing bio-compounds with nutritional, immunomodulatory and other functions. This complex microbial ecosystem reflects several factors (environment, feeding regimen, fish species, etc.). The objective of the present study was the identification of intestinal microbial strains able to produce molecules called biosurfactants (BSs), which were tested for surface and antibacterial activity in order to select a group of probiotic bacteria for aquaculture use. Forty-two bacterial isolates from the digestive tracts of twenty Mediterranean grey mullets were screened for testing emulsifying (E-24), surface and antibiotic activities. Fifty percent of bacteria, ascribed to Pseudomonas aeruginosa, Pseudomonas sp., P. putida and P. anguilliseptica, P. stutzeri, P. protegens and Enterobacter ludwigii were found to be surfactant producers. Of the tested strains, 26.6% exhibited an antibacterial activity against Staphylococcus aureus (10.0 ± 0.0–14.5 ± 0.7 mm inhibition zone), and among them, 23.3% of isolates also showed inhibitory activity vs. Proteus mirabilis (10.0 ± 0.0–18.5 ± 0.7 mm inhibition zone) and 6.6% vs. Klebsiella pneumoniae (11.5 ± 0.7–17.5 ± 0.7 mm inhibition zone). According to preliminary chemical analysis, the bioactive compounds are suggested to be ascribed to the class of glycolipids. This works indicated that fish gut is a source of bioactive compounds which deserves to be explored.

Prehabilitation and heart failure: perspective in primary outcomes, a randomized controlled trial

OBJECTIVE

Prehabilitation, intended as a multidisciplinary approach where physical training is combined with educational and counselling training, in cardiology could optimizing care, and has been shown to be able to reduce morbidity and mortality in several diseases. The present study aims to assess the effectiveness of a prehabilitation program in elderly patients (over 65) with chronic heart failure and to evaluate functional and quality indices of life.

PATIENTS AND METHODS

This is randomized, single blind controlled trial. Fourteen older adult patients diagnosed with chronic heart failure were enrolled. Patients were randomly assigned into the study or the control group. Patients in the study group underwent physical training organized into 10 twice-weekly meetings, nutritional and lifestyle counseling.

RESULTS

In the Study Group, the quality of life improved significantly (EQoL-5D), and between the two groups there is a statistically significant difference in the motor dimension of SF-36.

CONCLUSIONS

Because of our preliminary results, prehabilitation program should be included among the management strategies of in elderly patients with chronic heart failure to better manage their disease and to improve their Quality of Life.

A Note on the Tracing of Herbage Contribution to Grazing Sheep Diet Using Milk and Feces Biomarkers

Milk from grazing ruminants is usually rich in beneficial components for human health, but distinguishing milks sourced from grazing is difficult, and this hinders the valuing of the grazing benefit. This study aimed at evaluating the ability of milk biomarkers (1) to trace milks sourced from sheep submitted to different access times (ATs) to pasture and (2) to estimate sheep herbage dry matter intake (HDMI, g DM ewe^-1 d^-1) and herbage percentage (HP, % DM) in sheep diet. Animal data derive from a published experiment in which six replicated groups of mid-lactation Sarda sheep had ATs of 2, 4, or 6 h d^-1 to a ryegrass pasture. Sheep HDMI and HP of each group were measured on four dates in April 2013. Group milk was sampled, and milk fatty acids (FAs) and n-alkanes were determined by gas chromatography. The latter markers were also measured in feces samples bulked by group. The data (N = 24 records) were submitted to Linear Discriminant Analysis (LDA) aimed at distinguishing the AT to pasture based on biomarkers previously selected by Genetic Algorithms (GA). Partial Least Square Regression (PLSR) models were used to estimate HDMI and HP using biomarkers selected by GA. Based on one milk alkane and six milk FAs as biomarkers, estimates of the AT using GA-LDA were 95.8% accurate. The estimation of HDMI by GA-PLSR based on five milk FAs was moderately precise [explained variance = 75.2%; percentage of the residual mean square error of cross-validation over the mean value (RMSECV%) = 15.0%]. The estimation of HP by GA-PLSR based on 1 milk alkane and 10 FAs was precise (explained variance = 80.8%; RMSECV% = 7.4%). To conclude, these preliminary results suggest that milks sourced from sheep flocks with AT to pasture differentiated by 2 h in the range 2-6 h d^-1 can be precisely discriminated using milk biomarkers. The contribution of herbage to sheep diet can also be precisely estimated.

Effect of local diets on nutritional and sensory quality of meat of indigenous goats in Tunisian arid regions

The valorization of natural resources in small ruminants feeding can reduce the cost of feed and produce good meat quality. The objective was to evaluate the effects of local feed resources on the physico-chemical aspects, the sensorial characteristics and the fatty acid profile of goat kid's meat. Twenty-six kids are divided in three groups (average body weight = 15.85 kg; age = 4 months). The groups received oat hay (group control C), dried olive leaves + dried Stipa tenacissima (group OL) or grass hay (group Ko). The animals were slaughtered after 90 days of experience, with an approximate final live weight of 18.5 kg. Total solids, pH, fat, crude protein, vitamin, cholesterol and fatty acid contents of meat were determined. The OL group had the highest ultimate pH (6.82 vs. 6.73); cooking loss, gross composition (total solids, protein and fat), cholesterol and colour coordinates (L, a* and b*) were similar among groups. The vitamin E, affected by diet, was higher in group OL than the other groups (3.71 mg/kg vs. 1.32 and 2.17 mg/kg, respectively, for C and Ko groups). Moreover, meat from this group showed the highest saturated fatty acid. Unsaturated fatty acids content was higher in the meat of C and Ko groups. On the other side, polyunsaturated fatty acid level was not affected by the diet treatment. The n6/n3 ratio was significantly affected by the diet; it was lower in meat of groups Ko and OL (3.17 and 3.38 respectively). The feeding effect on sensory quality of meat was not significant.

Contact Transscleral Cyclophotocoagulation with Diode Laser in Refractory Glaucoma

OBJECTIVE

To evaluate the clinical effectiveness of contact transscleral cyclophotocoagulation (CTCP) with diode laser.

DESIGN AND PATIENTS

Forty-eight seeing eyes and 20 blind and painful eyes of 68 patients suffering from refractory glaucoma were treated using a diode laser (EOS3000, Laser Science) coupled with a 400-microns optic fiber ending in a 3-mm focusing tip. Sixteen to twenty 3.9-J (2.6 W x 1.5 to 2.5 s) laser spots were placed over 360 degrees, 1.5 mm from the corneolimbal junction.

RESULTS

In the seeing-eye group, the follow-up was 20.7 +/- 8.14 months, pre- and posttreatment IOPs were 37.1 +/- 11.27 and 19.5 +/- 8.73 mmHg respectively (p < 0.0001), and success (IOP > 2 and < or = 21 mmHg) was 70.8%. No significant visual acuity change was found in the successful eyes, whereas a significant visual acuity reduction was found in the unsuccessful cases (p = 0.03). In the blind-eye group, the follow-up was 20.5 +/- 8.54 months, pre- and post-treatment IOPs were 50.7 +/- 15.05 and 20.6 +/- 13.99 mmHg respectively (p < 0.0001), and success (remission of pain) was 100%. As for complications, one seeing eye developed a spontaneously-resolved vitreous hemorrhage and one seeing and one blind eye became hypotonic, though no phthysis was observed. No conjunctival or lens damage was detected, and no scleral thinning was revealed by ultrasound biomicroscopy. No case of sympathetic ophthalmia was found.

CONCLUSIONS

Diode laser can be successfully employed for CTCP in refractory glaucoma.

Viscocanalostomy: A Pilot Study

Purpose

Viscocanalostomy is a new, non-penetrating procedure for glaucoma surgery. We started a prospective study to assess the effectiveness and safety of the operation.

Materials and methods

Up to March 1998 we enrolled 33 patients (33 eyes) suffering from glaucoma, uncontrolled despite maximum medical therapy, who underwent viscocanalostomy according to Stegmann's technique. A complete ophthalmological examination was performed the day before surgery and on days 1 and 7 postoperatively. Further visits were scheduled at months 1, 3, 6 and 12.

Results

In four eyes Schlemm's canal was either missed or not deroofed properly, and the procedure was converted into simple trabeculectomy. After a mean follow-up of 3.0±2.6 months (range 1–10), success defined as IOP > 2 and < 21 mmHg with no medication was obtained in 86.2% of the cases (25/29); 23 out of 29 eyes (79.3%) had IOP > 2 and < 16 mmHg. In the 25 successful eyes, mean IOP was 27.7±9.5 mmHg (range 13–48) preoperatively and 12.0±3.0 mmHg (range 7–18) (p<0.0001) at the end of the follow-up period. Mean VA ranged from 0.35±0.34 to 0.32±0.32 (n.s.).

Intraoperative complications included

Descemet rupture (7), with iris plugging in two cases; choroidal deroofing (3), irregular incision of Schlemm's canal (2). Postoperative complications included: self-resolving 2-mm hyphema (4); IOP spike (1); inadvertent filtering bleb (2); hypotony with choroidal detachment for one week (1).

Conclusions

In this short-term study, viscocanalostomy proved effective and safe in lowering IOP in glaucomatous eyes.

Quality and fatty acid profile of the milk of indigenous goats subjected to different local diets in Tunisian arid lands

The study tested the hypothesis that certain pastoral forages and olive by-products, available in arid areas, may positively influence fatty acid composition and physicochemical properties of goat's milk. Thirty indigenous goats (body weight = 25.2 kg; age = 4.1 years) were allocated to three groups. During 60 days, the goats received ad libitum either dried olive leaves + Stipa tenacissima (group OL), khortane grass hay (group Ko) or oat hay (control diet, group OH). Milk samples were collected and analysed for total solids, fat, protein, lactose and ash content and fatty acid profile. Average milk yield did not statistically differ among groups. Milk total solids from OL group were higher in comparison with Ko and C groups (15.3, 14.7 and 14.5%, respectively; p < 0.05). Fat content was also higher for the OL group as compared to the other groups (5.44 vs. 5.01 and 4.66%, respectively, for Ko and OH). No significant differences were observed for the milk content of lactose, protein and ash. The percentage of saturated fatty acids of total milk fat was higher in OL and Ko groups compared to the C group (p < 0.001); the milk whereof was characterized by the highest percentage of monounsaturated (p < 0.01) and total unsaturated fatty acids. Milk fat of Ko and C groups showed significantly higher proportions of rumenic (CLA cis-9 trans-11) and vaccenic acids (C18:1 trans-11) compared to OL milk. The feeding system based on Stipa tenacissima and dried olive leaves resulted in the milk lowest proportion of trans-fatty acids and the highest proportion of polyunsaturated ω3-fatty acids (p < 0.05).

Effect of whey concentration on protein recovery in fresh ovine ricotta cheese

Ricotta cheese, particularly the ovine type, is a typical Italian dairy product obtained by heat-coagulation of the proteins in whey. The aim of this work was to investigate the influence of whey protein concentration, obtained by ultrafiltration, on yield of fresh ovine ricotta cheese. Ricotta cheeses were obtained by thermocoagulation of mixtures with protein content of 1.56, 3.10, 4.16, and 7.09g/100g from the mixing of skim whey and ultrafiltered skim whey. A fat-to-protein ratio of 1.1 (wt/wt) was obtained for all mixtures by adding fresh cream. The initial mixtures, as well as the final ricotta cheeses, were analyzed for their composition and by SDS-PAGE. Protein bands were quantified by QuantityOne software (Bio-Rad, Hercules, CA) and identified by liquid chromatography-tandem mass spectrometry. Significant differences in the composition of the ricotta cheese were observed depending on protein concentration. Particularly, ricotta cheese resulting from the mixture containing 7.09g/100g of protein presented higher moisture (72.88±1.50g/100g) and protein (10.18±0.45g/100g) contents than that prepared from the mixture with 1.56g/100g of protein (69.52±1.75 and 6.70±0.85g/100g, respectively), and fat content was lower in this sample (12.20±1.60g/100g) compared with the other treatments, with mean values between 15.72 and 20.50g/100g. Each protein fraction presented a different behavior during thermocoagulation. In particular, the recovery of β-lactoglobulin and α-lactalbumin in the cheese increased as their content increased in the mixtures. It was concluded that concentrating ovine rennet whey improved the extent of heat-induced protein aggregation during the thermal coagulation process. This resulted in a better recovery of each protein fraction in the product, and in a consequent increase of ricotta cheese yield.

ELISA and LC-MS/MS methods for determining cyanobacterial toxins in blue-green algae food supplements

The use of natural products as a diet supplement is increasing worldwide but sometimes is not followed by adequate sanitary controls and analyses. Twenty samples of pills and capsules of lyophilised cyanobacteria (blue-green algae), commercialised in Italy as dietary supplements, were found positive at the Vibrio fischeri bioassay. Further analyses with ELISA and LC-MS/MS methods revealed the presence of four microcystin (MC) analogues, MC-LR, -YR, -LA, -RR and two demethylated forms of MC-RR. The highest total microcystin content was 4.5 and 1.4 microg g-1 in pills and capsules, respectively. The ELISA measurements, compared to the LC-MS/MS analyses, showed significantly lower concentrations of microcystins in pills, this confirming a possible ELISA underestimate of mixed microcystins, due to different sensitivities for some toxic analogues.

Identification and quantification method of spiramycin and tylosin in feedingstuffs with HPLC-UV/DAD at 1 ppm level

The use of the two macrolides antibiotics Spiramycin (S) and Tylosin (T) as growth promoters in animal feeding has been recently withdrawn in the European Union due to a concern about the outbreaks of farmacoresistance fenomena as a possible hazard for humans. For feed additives monitoring purposes, an analytical method has been developed for their extraction, purification and identification in different animal feedingstuffs (pelleted beef, pig, poultry feeds and calves milk replacer) at a minimum performance required limit (MRPL) of 1 microg g(-1) (ppm). Such limit has been established according to the lowest dosage of additives still able to elicit an appreciable growth promoting effect. Blank feeds were spiked at two concentration levels, 1.0 and 2.5 ppm in six replicates. After methanolic extraction, samples were cleaned up on SPE CN columns and extracts analysed in HPLC-UV/DAD, using a gradient elution. Detection limits, calculated as the tree time mean noise of 20 blank feeds, were 176 and 118 ng g(-1) for S and T, respectively. Results show good repeatability (CV% not exceeding the value of 15) and mean recovery in the range of 99-74% and 81-53% for S and T, respectively, at 1 ppm. When the standards were injected up to 250 ng the chromatographic method can resolve the components of analytes (Spiramycin I, II and III; Tylosin A and B) but can not resolve the components on real feed samples at the spiked levels considered. For this reason the identification and quantification of analytes on matrix were carried out considering the main compound of the drugs (Spiramycin I and Tylosin A). As a verification, the overlapping of UV spectra in the range 220-350 nm between analytical standards and the compounds in the matrix were considered.

Tension-Free Vaginal Tape and Female Stress Incontinence: Further Evidence of Effectiveness

OBJECTIVES

Female stress incontinence is a frequent and distressing event with subsequent impact on quality of life. The tension-free vaginal tape (TVT) technique is considered to fulfill the criteria for an ideal surgical procedure and we therefore reviewed our cases to further analyze its effectiveness.

MATERIALS AND METHODS

57 patients suffering from stress incontinence with grade 1-2 cystocele underwent the TVT operation. During follow-up (mean 22.2 months), the short- and long-term results were investigated.

RESULTS

91.3% of patients achieved complete resolution of previous stress incontinence in the early postoperative period. Early complications occurred in 8.7% of patients. Follow-up (mean 22.2 months) highlighted the stabilization of positive outcomes in 87.7% of cases. No postoperative modification of sexual habits and a significant improvement in quality of life were reported by all patients.

CONCLUSION

The results of our study confirm that the TVT technique for stress incontinence is an easy to perform procedure which is safe, effective and long-lasting.

Traceability of inbred and crossbred Cinta Senese pigs by evaluating the oxidative stress

Previous studies on the oxidative stress in swine indicated a strong link between the values of reactive oxygen metabolites (ROMs), the subsequent antioxidant adaptive response (OXY) and the genetic selection. Such findings, mainly related to a cardiovascular inadequacy in lean, large muscle blocks and fast growing breeds, is associated with specific metabolic diseases such as porcine stress syndrome and mulberry heart disease. In this study, we investigated the oxidative stress parameters to trace the genetics of Cinta Senese (CS) pigs, a historical breed free-range reared in Siena countryside. Sera from CS (n = 24) and Large White x CS (LW x CS) (n = 24) groups around 120 kg body weight fed the same diet were sampled at slaughter. Sera from wild boars (WB) (n = 24) hunted in the same district were also considered. ROMs and OXY were evaluated in the three groups of swine. Significant differences by one-way anova (P < 0.05) between groups were found for both procedures. ROM levels were lower in WB (9.79 +/- 5.76 mm H2O2) and CS (18.02 +/- 7.42 mm H2O2), and highest in LW x CS (42.78 +/- 8.61 mm H2O2). OXY values ranged from 271.37 +/- 50.90 microm neutralized HOCl (WB) to 343.21 +/- 57.45 microm neutralized HOCl (LW x CS). Results indicated that the evaluation of the oxidative stress can effectively trace the CS pigs, thus aiding in preserving the overall specific traits of such a historical animal.

Extraction, clean-up and gas chromatography-mass spectrometry characterization of zilpaterol as feed additive in fattening cattle

Zilpaterol is an adrenergic drug currently licensed in Mexico and South Africa as a feed additive for cattle close to consignment. In this study an analytical method to detect zilpaterol in commercial feeds was set up. The influence of extraction solvent and matrix was evaluated. The drug as a trimethylsilyl derivative was characterized by GC-MS, on a quadrupole detector, in the electron impact mode. Acidic extraction, solid-phase extraction C(18) non-endcapped clean-up and mass characterization on ions m/z 308, 291, 405, 390 provided zilpaterol recoveries >75.3% and repeatability <3.3% in feeds spiked in the range 30.0-120.0 ng/g. The limits of detection and quantification were 7.5 and 25.0 ng/g, respectively. Such limits are well below the dose of 5.0-20.0 microgram/g proposed as effective.

Use of molecularly imprinted polymers in the solid-phase extraction of clenbuterol from animal feeds and biological matrices

Clenbuterol molecularly imprinted polymers (MIPs) as chromatographic stationary phase for the solid-phase extraction (SPE) of the drug from biological samples have been prepared. Propylene columns filled with 500 mg of clenbuterol MIPs have been tested with respect to their loading capacity, memory effects, selectivity toward related drugs (mabuterol, clenproperol, clenisopenterol, ritodrine) and specificity toward interferences arising from heterogeneous matrices such as animal feeds, bovine urine and liver. Analytes were concentrated on Extrelut 20 columns and the residues resuspended in 70% acetonitrile. Application, washing and elution fractions were collected and analyzed by HPLC-diode array detection. Results indicate this MIP approach in SPE is extremely selective for clenbuterol, mabuterol, clenproperol and clenisopenterol (>95% found in the eluate), with a loading capacity of about 20 microg/100 mg of stationary phase. Ritodrine showed a recovery rate of 51%. The molecular recognition mechanism is so specific to allow clenbuterol detection and identification by conventional detectors at level of interest (ppb) also from complex matrices such as feeds, urine and liver.

Determination of ethyl-p-hydroxybenzoate in sow pancreatic juice by reversed-phase high-performance liquid chromatography

We have developed a high-performance liquid chromatographic-UV-Vis-diode-array detection (HPLC-DAD) method for the determination of ethyl-p-hydroxybenzoate, a hydrolytic degradation product of the synthetic protease inhibitor, gabexate-mesilate ethyl-p-(6-guanidinohexanoyloxy) benzoate methanesulfonate (GM) (FOY) in sow pancreatic juice. Methyl-p-hydroxybenzoate (I) was used as the internal standard. The pancreatic juice was deproteinised by acetonitrile and the analytes were chromatographed on a reversed-phase C18 LC column using the gradient elution method. The mobile phase consisted of a solution of 0.017 M orthophosphoric acid and another solution of acetonitrile-water (80:20, v/v). The wavelength of detection was 237 nm. The limit of quantification of the method was 0.20 microM at a 9:1 signal-to-noise ratio. The overall intra- and inter-day accuracy (relative error, RE) ranged from 14.2 to 8.3% and from 13.3 to 9.8, respectively. The overall intra- and inter-day precision (relative standard deviation, RSD) ranged from 7.6 to 2.62% and from 6.7 to 3.1%, respectively. The method proved to be sensitive, specific, accurate and precise and was successfully used to determine the ethyl-p-hydroxybenzoate (II) in sow pancreatic juice.

Evaluation of the oxidative stress in growing pigs by microplate assays

The ability of pigs to neutralize the reactive oxygen species (ROS) plays a key role in their welfare. Two micromethods were developed to evaluate the oxidative stress and the anti-oxidative response in sera. We tested these methods for linearity, repeatability and reproducibility. A hydroxyl radicals (HR) test, based on the Fenton reaction, showed a linearity between 0.26 and 4.5 mM H2O2 (r = 0.997), with a coefficient of repeatability (CVr) of 1.9 and a coefficient of reproducibility (CVR) of 2.9. An anti-oxidant power (AOP) test, based on the capability of sera to neutralize a titred hypochlorous acid solution (HClO), showed a linearity between 55 and 880 microM HClO neutralized (r = 0.984), with CVr = 3.1 and CVR = 4.9. We assessed the applicability of such tests in field conditions on three different farms. Farm A recorded a positive anamnesis of Mulberry heart disease. Dietary Vitamin E supplementation was given at 50 p.p.m. in farms A and B and at 150 p.p.m. in farm C, respectively. The group from farm A showed HR sera levels higher than those of farm B and farm C (farm A, mean = 31.61 +/- 2.87 mM H2O2, n = 10; farm B, 28.53 +/- 2.30, n = 10; and farm C, 25.63 +/- 1.03, n = 10; P < 0.01). The AOP test was not able to discriminate between farms. The AOP levels found (mean = 472.50 microM HClO neutralized: n = 30) probably represent the maximum response of the organism to compensate the oxidative stress. HR and AOP are stable in sera stored at +4 degrees C. We discuss the application of such methods for the assessment of farmed animals' welfare.

Percutaneous US-guided radiofrequency ablation of hepatocellular carcinomas: results in 15 patients

BACKGROUND

The majority of patients with hepatocellular carcinoma (HCC) cannot undergo surgery because of multifocality, location or advanced cirrhosis. Our experience with percutaneous radiofrequency ablation for treatment of patients suffering from unresectable hepatocellular carcinoma is described here.

PATIENTS AND METHODS

Fifteen patients (ten men and five women) with eighteen primary hepatocellular tumors underwent percutaneous radiofrequency ablation. The mean diameter of the HCCs was 32 mm (ranging from 15 mm to 62 mm). The patients were treated under ultrasound guidance using either a 18-gauge internally cooled electrode or a 14-gauge electrode with four expandable hooks.

RESULTS

Complete necrosis was achieved in 15 lesions after one session of RF ablation. The persistence of a small portion of viable tissue was seen in two lesions. One lesion was not evaluable. After a mean follow-up period of 9.2 months (range 3-24 months), eleven patients (76%) showed no sign of local or distant recurrence, one patient developed a new lesion and one of two patients with persistence of viable tissue obtained a complete necrosis after the injection of percutaneous ethanol. Moreover, a major complication (intraperitoneal bleeding requiring surgical treatment) and three minor complications (1 pleuric effusion and 2 perihepatic fluid collections that resolved spontaneously) were observed.

CONCLUSION

RF ablation is a simple, well-tolerated and effective procedure for the treatment of unresectable hepatocellular carcinomas.

Phytotoxicity to and uptake of flumequine used in intensive aquaculture on the aquatic weed, Lythrum salicaria L

Phytotoxicity of Flumequine on the aquatic weed Lythrum salicaria L. was determined by two laboratory models: a single concentration test, by which the effects of 100 mg l-1 were evaluated after 10, 20, 30 days and a multiple concentration test, by which the effects of 5000-1000-500-100-50 micrograms l-1 were evaluated after 35-day exposure. 100 mg l-1 are highly toxic and significantly decrease the growth of plants; this effect increases with time. Concentrations between 5000 and 50 micrograms l-1 induced hormesis in plants, by significantly increasing mean number and dimension of leaves and secondary roots. The effect is the highest at 50 micrograms l-1 and decreases with increase in concentration. Both toxic effect and hormesis can be related to plant drug uptake, quite high, in the order of micrograms g-1. The ecological implication of Flumequine contamination in aquatic environments and the possible use of Lythrum salicaria for bioremediation and/or monitoring technique are discussed.

Treatment of hyperfiltering blebs with Nd:YAG laser-induced subconjunctival bleeding

PURPOSE

To assess the feasibility of a new technique to manage hyperfiltering blebs after penetrating glaucoma surgery.

METHODS

Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser bursts were used to induce bleeding in conjunctival and episcleral vessels in the bleb area to achieve local delivery of autologous blood.

RESULTS

In the three cases reported here in which this technique was used, the treatment was successful and safe, leading to resolution of hypotony and reduction of the bleb with no complications.

CONCLUSION

Subconjunctival bleeding can be achieved using Nd:YAG laser, and can represent a valuable alternative to autologous blood injection in cases of hyperfiltration after glaucoma surgery.

Alpha 1-acid glycoprotein affinity columns for the clean-up of adrenergic drugs

alpha 1-Acid glycoproteins (AAGs) have a structure resembling beta-adrenergic receptors and bind several basic drugs in plasma. Chromatographic columns were prepared by linking epsilon-NH2 groups of AAG lysines to a Sepharose 4B support, in order to purify by affinity chromatography adrenergic drugs of possible use in animal production. Loading capacities, binding efficiency, memory effects and matrix interferences from urine samples were studied. The method developed involves sample application in buffered media (pH 7.4), washing with 5 ml of PBS, and elution with 4 ml of 1% v/v acetic acid. Under these conditions no memory effect was observed. Loading capacity is correlated with the physiological plasma binding rate (PB) of the drug. For clenbuterol (PB 50%) and anilino-like related drugs, 5 mg of AAG were able to bind about 15 x 10(-6) g of drug, with a 100% recovery from the column. Repeatability and reproducibility, expressed as RSD, were 4.2 and 5.4%, respectively. The calculated AAG: drug molar ratio was 4.5:1, indicating 22% of the AAG bound to the column retained drug affinity. Among phenolic-like agonists, salbutamol (PB 5%), fenoterol and isoxsuprine hardly interacted, whereas nylidrin, ritodrine and bamethan showed more effective binding. We also checked binding of other drugs of possible use in veterinary medicine. Application of the AAG column to spiked bovine urine revealed a mean recovery of 97.8%; no matrix interferences were observed.

A possible correlation between the blood leukocyte formula and the use of glucocorticoids as growth promoters in beef cattle

Clinical analyses designed to set welfare parameters were performed on blood drawn from the caudal vein of 14 groups of cattle (young bulls and heifers) (n = 10) from 480 to 550 kg b.w., each group representative of a different farm. The leukocyte formula exhibited a lymphocytopenia in four groups compared with the values from a control group (n = 50). This finding was related to the possible illicit use of corticoids as growth promoters in meat production. The individual plasmas tested negative by two different ELISA kits for corticosteroids, but chemical analyses by LC-MS/APCI (detection limit 0.5 ng/ml) on the pooled plasma of each of the 14 groups revealed the presence of beclomethasone and fluocinolone acetonide in 3 of the 4 suspect farms. These corticosteroids are not always efficiently screened by commercially available immunoassays. The epidemiological reliability of blood analysis as a screening test for such drugs is discussed in the light of the need for quality certification of the whole meat production processes 'from farm to fork', and for enhanced animal welfare.

Identification of main corticosteroids as illegal feed additives in milk replacers by liquid chromatography-atmospheric pressure chemical ionisation mass spectrometry

Corticosteroids were proposed as growth promoting agents to improve commercial quality of meat. We developed a liquid chromatography-atmospheric pressure chemical ionisation mass spectrometry (LC-APCI-MS) method able to identify the presence in milk replacers, when given by mouth, of dexamethasone, betamethasone, flumethasone, triamcinolone, predinisotone, prednisolone, methylprednisolone, fludrocortisone and beclomethasone, at levels in the range of 20-100 ppb. C18 solid-phase extraction, LC-RP C8 column separation, data acquisition (positive ions) in the scan range m/z 200-550 allowed us to differentiate and identify compounds by protonated molecules, their methanolic adducts and fragmentation patterns.

Nd:YAG laser iridotomy in pigment dispersion syndrome: an ultrasound biomicroscopic study

AIMS

Ultrasound biomicroscopy was used to study the shape of the iris and the iridolenticular contact in pigment dispersion syndrome (PDS) eyes, to compare them with matched normal eyes, and to assess the morphological effects of laser iridotomy in PDS eyes.

METHODS

50 eyes of 50 patients suffering from PDS (group 1), and 15 normal eyes of 15 subjects matched for age and refraction (group 2), were studied by ultrasound biomicroscopy (UBM, Humphrey-Zeiss). Nd:YAG laser iridotomy was proposed to the 30 PDS patients with concave iris and 18 underwent the treatment.

RESULTS

The iris was concave in 27 eyes in group 1, and three more eyes showed a concave iris during accommodation. Among normals, iris concavity was present in two eyes. The height of the iris convexity was -0.15 (0.24) mm (range -0.65 to +0.21), in the eyes of group 1, whereas it was +0.07 (0.10) mm (range -0.21 to +0.16) in group 2 (p < 0.0012). Group 1 had greater iridolenticular contact than group 2: 1.55 (0.78) mm (range 0.30-2.88) and 1.07 (0.61) (range 0.30-2.50; p = 0.0304). After laser iridotomy, only one eye still had a concave iris. Pre- and post-treatment deflections were -0.35 (0.18) mm (range -0.61 to -0.05) and +0.01 (0.06) mm (range -0.12 to +0.17), respectively (p < 0.0001). Pre- and post-treatment iridolenticular contact was 2.10 (0.65) mm (range 0.70-2.88) and 0.93 (0.38) mm (range 0.4-1.75), respectively (p < 0.0001). After laser iridotomy, the treated irises were flatter than normal (p = 0.0207), whereas the iridolenticular contact was not significantly different.

CONCLUSIONS

Laser iridotomy can restore a normal iris shape and iridolenticular contact in eyes suffering from PDS.

[Chronic chondromalacia of the patella: comparison of morphological (magnetic resonance) and functional findings (isokinetic parameters) after rehabilitation]

The knee is a common site for injuries of the cartilage, capsule and ligament, which calls for the use of noninvasive techniques to assess injury severity properly and to plan adequate rehabilitation. Our study was aimed at comparing MR with isokinetic findings. To this purpose, 40 patients were examined; they were all affected with chondromalacia patellae, grades I-III, previously diagnosed at arthroscopy. Namely, 8 patients had grade I and 32 grades II and III chondromalacia. After MR and isokinetic exams, all patients were submitted to a standardized rehabilitation program. Our results indicate a marked decrease in quadriceps strength, especially in the most severe cases; in less severe cases, recovery was complete at 6 months, while the deficit remained in grades II and III injuries. MR yield was not relevant in 4 of 8 cases, while isokinetic findings were negative in one case. Both methods were positive in the most severe cases. At 6 months, both functional and MR findings were normal in grade I injuries, while some alterations remained in the others.

Cistectomia Totale Allargata: Primi Risultati di uno Studio di Valutazione del Contenuto di DNA in Citometria a Flusso

Ploidy was evaluated through cytometric analysis on samples from 20 patients who underwent extended total cystectomy. Neoplastic samples showed aneuploidy except in cases of villous bladder (diploid profile). Samples from healthy tissue were diploid. These preliminary results show that bladder mapping associated with flow cytometry could be an important parameter for choosing between conservative or radical surgery.

Citometria a flusso nei tumori della vescica trattati con tecnica chirurgica endoscopica

The Authors used flow cytometry to evaluate 62 patients who had undergone TURV for bladder tumour. The aim of the study was to investigate any relationship between an aneuploid polyclonal state and short-term local recurrence of the disease. Patients with recurrences after TURV had a high rate of aneuploidy. Despite the short follow up, these results show how important cytoflowmetry is in the clinico-therapeutic planning of bladder carcinoma.

THINKable, a computerized cognitive remediation. First results

We have carried out the first study in Italy on the cognitive remediation by a new computerized system developed by IBM and called THINKable. Statistical analyses revealed that on some measures there was a significant improvement in the level of performance of the subjects at the time of the posttreatment assessment compared with the pretreatment assessment. Disorders of memory and higher cognitive functioning improved by structured retraining, independently of attention. Improvement has been matched by changes in the patients real-word functioning. Senile patients also took advantage from cognitive training. They were already followed before as outpatients and had no spontaneous recovery. The role of personal computers in neuropsychological training is discussed.

Paraganglioma of the bladder: Description of two cases

Two cases of paraganglioma of the bladder, a rare neoplasm of chromaffin tissue, are reported. The first patient was a woman presenting a large neoplasm of the bladder (1.9×7.2 cm). The second patient presented a neoplasm of the bladder wall. Surgical therapy was the treatment of choice. Prolonged follow-up is necessary.