Do one-stage indications predict success following two-stage arthroplasty for chronic periprosthetic joint infection?

Introduction: The 2018 International Consensus Meeting (ICM) proposed criteria for one-stage exchange arthroplasty in treating periprosthetic joint infection (PJI). Our study aimed to determine what proportion of PJI patients met the 2018 ICM criteria and how this affected infection-free survivorship for patients. Methods: All chronic PJI patients treated with two-stage exchange within our institution between 2017-2020 were retrospectively reviewed. Included cases met 2011 Musculoskeletal Infection Society (MSIS) criteria for PJI and had a 2-year minimum follow-up. Treatment success was defined as Tier 1A in the 2019 MSIS working group definition. ICM one-stage criteria included non-immunocompromised host, absence of sepsis, adequate soft tissue for closure, known preoperative pathogen, and susceptibility. Immunocompromised host was analyzed as two separate definitions. Kaplan-Meier survivorship, Cox regression, and univariate analyses were performed. Results: A total of 293 chronic PJI patients were included. Overall, treatment failure occurred in 64 / 293 (21.8 %) patients. Only 13 % (n = 37 ) met ICM criteria definition no. 1 for one-stage exchange; 12 % (n = 33 ) met definition no. 2. In both definitions, infection-free survivorship at 2 years did not differ between patients who met and did not meet criteria (p > 0.05 ). Cox proportional hazard regression analyses demonstrated that the only variable predicting treatment failure was knee joint involvement (p = 0.01 ). Conclusions: We found that a very limited number of chronic PJI patients were suitable for a one-stage exchange. Furthermore, the supposition that healthier hosts with known pathogens (the basis of the ICM criteria) yield better PJI treatment outcomes was not observed. These results justify the ongoing multicenter randomized control trial comparing one-stage versus two-stage treatment for chronic PJI.

Dalbavancin is thermally stable at clinically relevant temperatures against methicillin-sensitive Staphylococcus Aureus

Introduction: While the rate of orthopaedic infections has remained constant over the years, the burden on healthcare systems continues to rise with an aging population. Local antibiotic delivery via polymethyl methacrylate bone cement is a common adjunct in treating bone and joint infections. Dalbavancin is a novel lipoglycopeptide antibiotic in the same class as vancomycin that has shown efficacy against Gram-positive organisms when used systemically but has not been investigated as a local antibiotic. This study aims to identify whether dalbavancin is thermally stable at the temperatures expected during the polymerization of polymethyl methacrylate cement. Methods: Stock solutions of dalbavancin were prepared and heated using a polymerase chain reaction machine based upon previously defined models of curing temperatures in two clinically relevant models: a 10 mm polymethyl methacrylate bead and a polymethyl methacrylate articulating knee spacer model. Aliquots of heated dalbavancin were then transferred to be incubated at core body temperature (37 ∘ C) and analyzed at various time points up to 28 d. The minimum inhibitory concentration at which 90 % of colonies were inhibited (MIC90 ) for each heated sample was determined against methicillin-sensitive Staphylococcus aureus (American Type Culture Collection, ATCC, 0173K) using a standard microbroth dilution assay. Results: The average MIC90 of dalbavancin was 1.63 µ g mL - 1 ± 0.49 against 0173K S. aureus. There were no significant differences in the relative MIC90 values after heating dalbavancin in either model compared to unheated control dalbavancin. Conclusions: Dalbavancin is thermally stable at the curing temperatures of polymethyl methacrylate cement and at human core body temperature over 28 d. Future in vitro and in vivo studies are warranted to further investigate the role of dalbavancin as a local antibiotic prior to its clinical use.

The effectiveness of leadership: meta-analysis of trial, cross-sectional, and before after studies

Background

The clinical and surgical procedures are often based on scientifical evidence but 30-40% of patients do not receive treatment according to evidence based medicine. The main aim of this review and meta-analysis is to assess the effectiveness of leadership in healthcare setting.

Methods

It was conducted a literature research on MEDLINE, Pubmed and Scopus with publication year between 2015 and 2019. The inclusion criteria were studies involving healthcare workers that evaluated effectiveness of opinion leaders in improving behaviour of healthcare workers, according to clinical or patient related outcomes. The quality of studies were assesed with the NHLBI for before after studies and the NOS for other study designs. The effect of leadership was assessed as risk difference for all studies with the exception of cross sectional studies. For the last it was evaluated correlation between leadership level and outcome measurment.

Results

A total of 3,155 articles were screened and 284 were fully assessed including 22 of them in the final database: 1 randomized trial, 9 cross sectional and 12 before after studies. For the cross-sectional studies there was a correlation of 0.22 (95% CI 0.15-0.28) between leadership level and outcome measurment. In the metaregression analysis the only factor that increased the correlation was private setting (meta regression coefficent =0.52, p = 0.022). The pooled efficacy was 24% (95% CI 10%-17%) for before after studies. Furthermore, a higher effectiveness was revealed in studies conducted on multi professional (24%) than single professional (9%) healthcare workers.

Conclusions

According to results, the guidelines adherence and task performance increased in a setting with leadership implementation. The leadership effectiveness appears comparable to other strategies as audit and feedback used to implement evidence-based practice in worldwide healthcare.

Key messages

The translation of evidence into clinical practice is often difficult but this study suggests that leaderhip can had higher effectiveness in multiprofessional healthcare workers and private setting. The effectiveness of leadership in this review suggests that it can be of help in order to make aware healthcare professionals about effectiveness of comply with evidence-based practice.

Essential strategies in HAI prevention and control: performance assessment through the implementation of the HAI-CoSIP tool of the GISIO-SItI group. A pilot study in a sample of Italian Organizations

BACKGROUND

Healthcare-Associated Infections are a great concern for worldwide healthcare systems and represent a considerable threat to patient safety, leading to adverse clinical outcomes. A defined panel of indicators represents a key element to guide Healthcare Organizations towards identification of main gaps, implementation of effective actions and continuous improvements on Healthcare-Associated Infections prevention and control activities. A review on accreditation systems conducted by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene Preventive Medicine and Public Health revealed a substantial heterogeneity of implemented standards and led to the development of a core set of indicators and requirements for Healthcare-Associated Infections' prevention and control within the hospital setting. The main aim of the study was to test the feasibility of the Healthcare-Associated Infections' prevention and control within the hospital setting tool to calculate performance scores on a sample of Italian Healthcare Organizations and to identify major critical issues. The potential benefits of the possibility of future implementation of the tool within Institutional Accreditation Programs is discussed.

STUDY DESIGN

Cross sectional pilot survey.

METHODS

The Healthcare-Associated Infections' prevention and control within the hospital setting included 96 criteria and 20 key areas including an area for outcomes indicators. For applicable criteria, standards fulfilment was evaluated according to a 4 point Likert scale. A composite score was calculated for each Healthcare Organization and five performance levels were identified. Data were further analysed by computing performance scores at the level of each area and requirement.

RESULTS

20 Healthcare Organizations agreed to take part in this pilot study including two rehabilitative Healthcare Organizations. Among the whole sample a mean of 12.20% of requirements resulted not fulfilled, leaving space for further improvements. Critical areas were easily identified and the instrument was able to capture substantial differences between Healthcare Organizations. Only a few number of standards resulted "Not Applicable" (Mean = 4.71%) and most of them regarded Rehabilitative Healthcare Organizations. Mean composite performance index resulted 74.06% (SD = 16.96, range 36.30 - 94.27%); area of outcome indicators obtained a mean score of 56.17.

CONCLUSION

The Healthcare-Associated Infections' prevention and control within the hospital setting resulted an useful tool to assess Healthcare Organizations' performance in the field of Healthcare-Associated Infections prevention and control and to identify necessary actions for further improvements. The distribution of total scores by Healthcare Organizations showed a high heterogeneity. Implementation of the Healthcare-Associated Infections' prevention and control within the hospital setting tool as an institutional accreditation tool may help to drive the required harmonization at a national level of Healthcare-Associated Infections management and control strategies and overcome current substantial regional differences.

Vaginal birth after prior myomectomy

OBJECTIVE

The aim of this retrospective cohort study was to evaluate the obstetrical and perinatal outcomes of vaginal birth in case of pregnancies achieved after prior myomectomy. We also analyzed how operative characteristics at the time of surgery might influence the choice of obstetricians about mode of delivery.

STUDY DESIGN

We analyzed retrospectively all women who underwent laparoscopic (LPS) or laparotomic (LPT) myomectomy between January 2002 and December 2014, in a network of three Institutions belonging to the University of Milano Bicocca, Italy. Women were contacted by phone interview and only cases with available follow-up data and who had a subsequent pregnancy were included. Operative characteristics and subsequent obstetrical outcomes were recorded and analyzed.

RESULTS

469 women who underwent myomectomy were contacted by phone interview, and 152 pregnancies were achieved after surgery, 96 after LPS and 56 after LPT. A total of 110 pregnancies ended in deliveries at ≥24 weeks. Seventy-three (66.4%) women had trial of labor after myomectomy (TOLAM), while 24 (21.8%) had a planned cesarean delivery (CD). Sixty-six (90.4%) of the TOLAM cases successfully accomplished vaginal delivery. No cases of uterine rupture (UR) were reported, and all deliveries ended in live births. The incidence of Neonatal Intensive Care Unit admission was 14.5% (16/110), with no cases of perinatal death. Comparing the surgical details at the time of myomectomy, the incidence of uterine cavity entered was significantly higher in planned CD group compared to TOLAM cases (p < 0.001). No other significant difference between the two groups was reported.

CONCLUSIONS

A successful vaginal delivery was accomplished by 90.4% of women who had TOLAM, without any case of UR or severe maternal and perinatal complications. TOLAM may be considered and offered as feasible and relatively safe option. Obstetricians' attitude toward mode of delivery after prior myomectomy seems to be influenced by the reported entry into the uterine cavity at the time of surgery.

Pelvic positioning in the supine position leads to more consistent orientation of the acetabular component after total hip arthroplasty

Aims

This study aims to: determine the difference in pelvic position that occurs between surgery and radiographic, supine, postoperative assessment; examine how the difference in pelvic position influences subsequent component orientation; and establish whether differences in pelvic position, and thereafter component orientation, exist between total hip arthroplasties (THAs) performed in the supine versus the lateral decubitus positions.

Patients and Methods

The intra- and postoperative anteroposterior pelvic radiographs of 321 THAs were included; 167 were performed with the patient supine using the anterior approach and 154 were performed with the patient in the lateral decubitus using the posterior approach. The inclination and anteversion of the acetabular component was measured and the difference (Δ) between the intra- and postoperative radiographs was determined. The target zone was inclination/anteversion of 40°/20° (± 10°). Changes in the tilt, rotation, and obliquity of the pelvis on the intra- and postoperative radiographs were calculated from Δinclination/anteversion using the Levenberg–Marquardt algorithm.

Results

The mean postoperative inclination/anteversion was 40° (± 8°)/23° (± 9°) with Δinclination and/or Δanteversion > ± 10° in 74 (21%). Intraoperatively, the pelvis was anteriorly tilted by a mean of 4° (± 10°), internally rotated by a mean of 1° (± 10°) and adducted by a mean of 1° (± 5°). Having Δinclination and/or Δanteversion > ± 10° was associated with a 3.5 odds ratio of having the acetabular component outside the target zone. A greater proportion of THAs that were undertaken with the patient in the lateral decubitus position had Δinclination and/or Δanteversion > ± 10° (35.3%, 54/153) compared with those in the supine position (4.8%, 8/167; p < 0.001). A greater number of acetabular components were within the target zone in THAs undertaken with the patient in the supine position (72%, 120/167), compared with those in the lateral decubitus position (44%, 67/153; p < 0.001). Intraoperatively, the pelvis was more anteriorly tilted (p < 0.001) and more internally rotated (p = 0.04) when the patient was in the lateral decubitus position.

Conclusion

The pelvic position is more reliable when the patient is in the supine position, leading to more consistent orientation of the acetabular component. Significant differences in pelvic tilt and rotation are seen with the patient in the lateral decubitus position. Cite this article: Bone Joint J 2018;100-B:1280–8.

Definition of criteria and indicators for the prevention of Healthcare-Associated Infections (HAIs) in hospitals for the purposes of Italian institutional accreditation and performance monitoring

BACKGROUND

Healthcare-associated infections (HAIs) are an important issue in terms of quality of care. HAIs impact patient safety by contributing to higher rates of preventable mortality and prolonged hospitalizations. In Italy, analysis of the currently available accreditation systems shows a substantial heterogeneity of approaches for the prevention and surveillance of HAIs in hospitals. The aim of the present study is to develop and propose the use of a synthetic assessment tool that could be implemented homogenously throughout the nation.

METHODS

An analysis of nine international and of the 21 Italian regional accreditation systems was conducted in order to identify requirements and indicators implemented for HAI prevention and control. Two relevant reviews on this topic were further analyzed to identify additional evidence-based criteria. The project team evaluated all the requirements and indicators with consensus meeting methodology, then those applicable to the Italian context were grouped into a set of "focus areas".

RESULTS

The analysis of international systems and Italian regional accreditation manuals led to the identification respectively of 19 and 14 main requirements, with relevant heterogeneity in their application. Additional evidence-based criteria were included from the reviews analysis. From the consensus among the project team members all the standards were compared and 20 different thematic areas were identified, with a total of 96 requirements and indicators for preventing and monitoring HAIs.

CONCLUSIONS

The study reveals a great heterogeneity in the definition of accreditation criteria between the Italian regions. The introduction of a uniform, synthetic assessment instrument, based on the review of national and international standards, may serve as a self-assessment tool to evaluate the achievement of a minimum standards set for HAIs prevention and control in healthcare facilities. This may be used as an assessment tool by the Italian institutional accreditation system, also useful to reduce regional disparities.

FGF18 augments osseointegration of intra-medullary implants in osteopenic FGFR3(-/-) mice

Enhancement of endogenous bone regeneration is a priority for integration of joint replacement hardware with host bone for stable fixation of the prosthesis. Fibroblast Growth Factor (FGF) 18 regulates skeletal development and could therefore have applications for bone regeneration and skeletal repair. This study was designed to determine if treatment with FGF 18 would promote bone regeneration and integration of orthopedic hardware in FGF receptor 3 deficient (FGFR3(-/-)) mice, previously characterized with impaired bone formation. Rigid nylon rods coated with 200 nm of titanium were implanted bilaterally in the femora of adult FGFR3(-/-) and FGFR3(+/+) mice to mimic human orthopedic hardware. At the time of surgery, LEFT femora received an intramedullary injection of 0.5 μg FGF18 (Merck Serono) and RIGHT femora received PBS as a control. Treatment with FGF18 resulted in a significant increase in peri-implant bone formation in both FGFR3(+/+) and FGFR3(-/-) mice, with the peri-implant fibrous tissue frequently seen in FGFR3(-/-) mice being largely replaced by bone. The results of this pre-clinical study support the conjecture that FGF18 could be used in the clinical setting to promote integration of orthopedic hardware in poor quality bone.

Efficacy of human chorionic gonadotropin to induce ovulation in the mare, when associated with a single dose of dexamethasone administered at breeding time

REASONS FOR PERFORMING STUDY

Human chorionic gonadotropin (hCG) and dexamethasone have a role in the reproductive management protocols of mares susceptible to persistent mating-induced endometritis (PMIE). However, it is possible that there is interference between these 2 drugs.

OBJECTIVES

The objective of this retrospective study was to determine the efficacy of hCG to induce ovulation in mares treated with dexamethasone at breeding time.

METHODS

Medical records from 152 mares and 223 cycles were analysed. In 113 cycles, mares susceptible to PMIE were treated with 1500 iu hCG and a single dose of 50 mg dexamethasone, 110 cycles were used as controls and subsequent ovulation was assessed ultrasonographically and compared.

RESULTS

Dexamethasone did not inhibit ovulation in mares susceptible to PMIE.

CONCLUSIONS AND POTENTIAL RELEVANCE

Multiple administrations of dexamethasone to mares in early oestrus have induced ovulation failure. However, a single dose of dexamethasone, administered at breeding time, has been used as an effective modulator of PMIE in susceptible mares and does not interfere with efficacy of hCG to induce ovulation.

The anatomical collection of Giovan Battista Rini (1795-1856): A paleoradiological investigation

Eight anatomical preparations from the collection of Giovan Battista Rini (1795-1856) at the Desenzano Hospital Pathology Division (Brescia, Italy) were examined by computed tomography (CT). The aim of the study was to obtain detailed information on the state of preservation of these "anatomical mummies" and the techniques used to prepare them. Relying on the existing literature, the examined specimens (five heads with necks, two busts and one heart) could be divided into three types of anatomical specimens: "dry preparations," "corrosion preparations," and "organ preparations." CT examination enabled the assessment of the exact features of each specimen, some of the preparation techniques applied, the presence of foreign bodies, and the use of substances to fill the blood vessels. All of the cases demonstrated an extremely good state of preservation. The study sheds new light on important-yet scarcely known-preparation techniques created for different anatomical demonstrations. Results of the CT investigation were consistent with the anatomical preservation methods described in 18th to 20th century literature, particularly those of Italy.

Occurrence of Vibrio alginolyticus in Ligurian Coast Rock Pools (Tyrrhenian Sea, Italy) and Its Association with the Copepod Tigriopus fulvus (Fisher 1860)

A study of heterotrophic bacteria and vibrios adhering to the copepod Tigriopus fulvus, which lives in Ligurian coast rock pools (Tyrrhenian Sea), was carried out from November 1990 to October 1991. Heterotrophic bacteria, which were always found both free in the water and bound to the T. fulvus organisms, showed a correlation with water temperature and salinity. Vibrio alginolyticus was found free in the water and bound to T. fulvus surfaces during the warmest months. Temperature is the main factor influencing the presence of V. alginolyticus in the rock pool. Attachment of this microorganism to the copepod provides a mechanism for its extended geographic distribution.

Cytotoxicity of the venom of Pelagia noctiluca forskål (Cnidaria: Scyphozoa)

The activity of Pelagia noctiluca venom was never assessed on cultured cells; therefore, we have evaluated on V79 cells the cytotoxicity, genotoxicity and ATP depletion induced after treatment. Venom did not cause alteration on cell DNA, but showed remarkable cytotoxic properties. With the highest nematocyst concentration (150,000 nematocyst/ml) 74 and 39% cells survived after 1 and 3 h, respectively, when evaluated by Trypan blue. Treated cells showed increased ATP levels during the same time. Preliminary HPLC analyses have showed the occurrence of a protein containing peak.

Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC)

BACKGROUND

Lymph node metastases are present in only about 15% of patients with early gastric cancer (EGC) and for this reason, the majority of these patients do not require lymphadenectomy. In Japan, EGC patients undergo less invasive treatment (endoscopic mucosal resection, wedge resection, laparoscopy). However, the indications for and results of these types of treatment are still uncertain.

METHODS

In a multicentre retrospective study, we analysed the clinicopathological data referring to 584 early gastric cancer patients who underwent D2 gastrectomy. A comparison was made between patients with and without lymph node metastases in relation to numerous pre- and postoperative variables. Long-term survival and risk factors for lymph node metastases were analysed. The primary aim was to compare our results with those of Western and Japanese authors; we also evaluated the possibility of identifying a subset of patients at low risk of lymph node metastases who may be candidates for endoscopic treatment.

RESULTS

The incidence of lymph node metastasis was 14.4%. Univariate and multivariate analyses showed that submucosal infiltration, diffuse histotype, tumour size and Kodama Pen A type were all related to the presence of lymph node metastases. Patients with types I, IIa and IIb mucosal tumours did not present lymph node metastases. Postoperative mortality was 2.2%. Five-year survival in relation to lymph node groups was 95% in N0 patients, 77% in N1 patients and 60% in N2 patients (p = 0.0001, Japanese N-stage). The number of positive lymph nodes also had a prognostic value. Patients with three or fewer positive lymph nodes presented a better 5-year prognosis (83%) than those with more than three positive lymph nodes (48%) (p = 0.0001).

CONCLUSIONS

Our study confirms that lymph node involvement is an extremely important prognostic factor. For this reason, the therapeutic strategy of our surgical units is as follows: 1) D2 gastrectomy is the standard treatment even in early gastric cancer (EGC); 2) endoscopic mucosal resection (EMR) could be considered first in types I, IIa and IIb tumours that are diagnosed as limited to the mucosal layer.

Variations of ATP content in V79 cells treated with crude toxins of--Aequorea aequorea (Cnidaria: Hydrozoa) and Rhizostoma pulmo (Cnidaria: Scyphozoa). A preliminary study

The toxicity of Cnidaria exerts a noticeable influence on some human activities, such as fishery and bathing, and on public health. As toxins of Mediterranean Cnidaria are located in nematocysts and in tissues, in this study the influence of crude toxins (nematocyst and surrounding tissue venom) extracted from the jellyfish Aequorea aequorea and Rhizostoma pulmo on ATP content of cultured V79 cells was assessed. Using the crude toxin of A. aequorea an increase of ATP levels in treated cells was noted; highest values (41.2 10(-7) mM/ml after 180 min treatment) were reached using the highest dose. Otherwise, a generalized decrease of ATP levels was observed treating cells with crude toxin of R. pulmo; recorded values showed the complete depletion of cell ATP at 115 min treatment with the highest dose. A statistical significance was recorded between treatment times and between doses using crude toxin of R. pulmo, and only between treatment times for A. aequorea.

Prediction of Lymph Node Status by Analysis of Prognostic Factors and Possible Indications for Elective Axillary Dissection in T1 Breast Cancers

OBJECTIVE

To identify those patients with T1 breast cancers with lower risk of nodal metastases who can safely be spared axillary dissection.

DESIGN

Retrospective study.

SETTING

University hospital, Italy.

SUBJECTS

Review of clinical records and histopathological slides of 547 patients with T1 breast cancer, operated on between 1984 and 1997.

MAIN OUTCOME MEASURES

Incidence of axillary metastases in relation to age, menopausal status, diameter and grade of tumour, vascular invasion, DNA ploidy, S-phase fraction and hormone receptor state, by univariate and multivariate analysis.

RESULTS

Axillary metastases were present in 159 patients (29%). On univariate analysis, diameter of tumour 10 mm or less (pT1a/pT1b cancers), no vascular invasion, and grade 1 tumour were significantly correlated with a lower risk of nodal metastases, but only vascular invasion (p = 0.0001, odds ratio = 3.1) and diameter of tumour (p = 0.04, odds ratio = 1.6) were independent predictors on multivariate analysis. Among 34 pT1a/pT1b cancers, with low grade of tumour and no vascular invasion, only 2 (6%) had axillary metastases. When only one favourable predictive factor was associated with diameter of tumour of 10 mm or less, the incidence of axillary metastases ranged from 12% for 43 patients with grade 1 cancers to 13% for 76 patients with no vascular invasion.

CONCLUSIONS

Axillary dissection may be avoided in pT1a and pT1b breast cancers (< or = 10 mm), with low grade of tumour or no vascular invasion. T1 breast cancers 10 mm or less in diameter should be treated by a two-step approach, first wide excision of the tumour and then axillary dissection or not depending on pathological examination of the primary tumour.

An ultrastructural study of the Antarctic calanoid Copepod Metridia gerlachei giesbrecht, 1902. Adult female

Scanning electron microscopy (SEM) techniques can highly contribute to the knowledge of body structures in order to differentiate between different species or between varieties within the same species. This is particularly important in extreme environments, such as in Antarctic waters, where the evolution efforts have promoted the development of endemisms. In this work the external anatomy of Metridia gerlachei (Copepoda, Calanida) adult females, sampled during the Italian Oceanographic Campaign in Antarctica 1987-88, was described by SEM, particularly considering some swimming legs and the genital abdominal joint. The descriptions already reported have been verified and some morphological details have been better emphasized. As concerns the P2, the hook process of the first segment of endopod and a series of spines vaguely indicated, but not defined, in previous descriptions have been clearly evidenced. In the P5 the occurrence of three well separated free segments and the location of a marginal sets have been shown. The ultrastracture of the genital segment showed that a clear areola surrounds the genital field.

Cultures and thermal analysis of the marine microalga Tetraselmis suecica Kylin (Butch)

In this paper, the growth of the marine microalga Tetraselmis suecica was investigated using thermogravimetry (TG) and differential thermal analysis (DTA) to determine suitable diets for larval and juvenile development in aquaculture systems. Microalgae were maintained in synthetic sea water (19@1000 salinity, 18 degrees C constant temperature) and the algal growth was evaluated by cell abundance. Exponential, stationary and senescence cells were analyzed by TG and DTA. The results of thermal analysis pointed out marked differences between exponential, stationary and senescence phases and showed that exponentially growing microalgae could represent a suitable food in aquaculture systems.

Adhesion of bacteria and diatoms to the exoskeleton of the harpacticoid copepod Tigriopus fulvus in culture: electron and epifluorescent microscope study

In the marine environment associations between picoplankton and copepods are very important not only for the lifestyle of these animals, but also for marine ecosystems and human health. In the present study we investigated the biofouling of Tigriopus fulvus in culture and possible effects of this colonization by means of scanning electron microscopy and epifluorescence microscopy. These investigations show that T. fulvus is heavily and not uniformly colonized by bacteria and algae.

Application of the principal component analysis (PCA) to the ecological study of an artificial environment: the tunny-fishing net of Camogli (Ligurian Sea)

The management of the marine environment and resource exploitation depend on the knowledge of both water conditions and ecological relationships between organisms. In the framework of fishing problems, an adequate food availability is important in order to allow maintaining and growth of fish stocks. The tunny-fishing of Camogli, owing to the coco-fibre texture of its net, can improve the trophic resources allowing the settlement of organisms eaten by fish. The distribution and composition of settled organisms was studied during the campaign 1988 by microscopical methods. The results have been elaborated by using multivariate (PCA) methods. Foraminifers, ciliates, hydroids, nematodes and copepods were the mainly observed groups. Their variations with season and depth and the relationships with caught fish species are presented. The elaboration of data by PCA allowed an easy and complete interpretation of the obtained complex data set showing the existence of a "rope" and of a "depth" effect.

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.

Toxicity of Actinia equina (Cnidaria: Anthozoa) crude venom on cultured cells

The toxicity of Cnidaria is a subject of high concern owing to its influence on human activities and public health and to the implications in ecological relationships between organisms. In order to simulate as much as possible the natural conditions and the consequences of stinging against injured cells, as well considering that Cnidarian venoms are located not only in nematocysts but also in tissues, the cytotoxicity and genotoxicity of crude extracts from nematocyst and surrounding tissues of the sea-anemone Actinia equina (Cnidaria: Anthozoa) were assessed on cultured fibroblasts (V79). The cytotoxicity was remarkable and cell survival was highly reduced at highest tested concentration (150,000 nematocysts/ml); using the Trypan blue dye exclusion test, only 40% of treated cells survived after the first hour of treatment and viable cells were not counted after the second hour. Also the results obtained utilizing the Neutral Red assay showed serious effects of crude toxin (only 31.5% and 12.6% cell survival after one and three hours respectively). Genotoxic effects were not observed at tested doses.

Complications after surgery for gastric cancer in patients aged 80 years and over

Recent studies have shown a considerable increase in the number of aged patients with gastric cancer. In this retrospective study, we report our 18-year experience with 110 patients aged 80 years and over affected with this neoplasm. Postoperative morbidity and mortality rates and risk factors affecting their incidence were examined by univariate and multivariate analysis. Operability and resectability rates were 70.9% and 47.3% respectively. Of the resective procedures, 41 (78.8%) were subtotal gastrectomies. In five cases (9.6%), we performed combined resections. Twenty-five patients (32.1%) experienced postoperative complications; overall mortality rate was 12.8% (10 patients). In resective procedures, morbidity and mortality were 26.9% and 3.8% respectively, which are very low rates compared to other Western reports. Statistical analysis identified the number of preexisting medical illnesses as an independent predictor of morbidity and mortality. Crude five-year survival rate of curatively resected cases was 43%. Although multiple medical illnesses involved much higher operative mortality, neither the presence of postoperative complications nor the number of preexisting medical illnesses significantly influenced five-year survival rate of curatively resected patients. With careful evaluation and selection of patients, correct treatment of concomitant diseases and adequate peri- and postoperative care, gastric surgery provides good immediate and long-term results even in very old patients. Subtotal gastrectomy with limited lymphadenectomy should be the preferred procedure; total gastrectomy, combined resections and extended lymphadenectomy should be performed only when necessary, in patients with fewer than two illnesses. Surgery should be avoided in patients with highly advanced disease, if multiple medical illnesses are present.

The carotenoid pigments of a marine Bacillus firmus strain

As carotenoids have important biological functions, it is important to discover new natural sources of these pigments. The bacterial strains isolated from a sea water rock pool were cultivated on marine agar containing yeast extract and identified by conventional methods. The bacterial pigments were extracted with methanol and analyzed by reversed-phase HPLC with diode array detection. The major pigment of a Bacillus firmus strain was identified as astaxanthin; the results obtained suggest potential use of this bacterium in aquaculture and in pharmaceutical field.

Attachment of Vibrio alginolyticus to chitin mediated by chitin-binding proteins

Vibrio alginolyticus is the only culturable vibrio associated with the chitinaceous carapace of the copepod Tigriopus fulvus (Fisher 1860) living in Ligurian coastal rock pools (Tyrrhenian Sea). The characteristics of the interaction between chitin particles and V. alginolyticus were studied by analysing strains isolated both from the copepod surface and from rock-pool water. The highest degree of attachment to chitin was observed at 20 degrees C, in the presence of 3% NaCl. Bacterial treatment with N-acetylglucosamine and pronase E caused a reduction in attachment of 52-62% and 77-94%, respectively. Chitin pretreatment with either wheat germ agglutinin or membrane proteins (MPs) from V. alginolyticus caused a reduction in attachment, of 50-57% and 53-70%, respectively. No inhibition was observed when bacteria were pretreated with D-glucose, D-fucose or D-fructose, or when chitin was pretreated with concanavalin A and Escherichia coli DH5 alpha MPs. V. alginolyticus MPs able to bind chitin were isolated and analysed by SDS-PAGE. Four chitin-binding proteins were visualized in all tested strains (53, 35, 20 and 14 kDa); in vivo these peptides may efficiently mediate V. alginolyticus attachment to chitin-containing substrates.

Toxicity of jellyfish and sea-anemone venoms on cultured V79 cells

Cnidarian toxins exert an influence on human activities and public health. The cytotoxicity of crude toxins (nematocyst and surrounding tissue venom) of Aequorea aequorea, Rhizostoma pulmo and Anemonia sulcata was assessed on V79 cells. Rhizostoma pulmo and Anemonia sulcata crude venoms showed remarkable cytotoxicity and killed all treated cells at highest tested concentration within 2 and 3 hr, respectively. Aequorea aequorea crude venom greatly affected growth rate during long-term experiments. No genotoxic effect was observed.

[Cervical esophageal perforation caused by a foreign body: a clinical case]

The Authors report a case of cervical esophageal perforation from foreign body. Comparing their experience with data from literature, they point out the diagnostic importance of both X-ray studies, in order to demonstrate the site of the lesion, and CT scans, to have accurate information on perilesional infective complications (abscesses). Early surgical treatment, with primary closure of perforation and adequate drainage, associated with antibiotics and enteral or total parenteral nutrition, allows good results in most cases.

[Diverticulosis and neoplasms of the colon]

About half of the carcinomas and polyps of the large intestine is placed in the descendent colon and in the sigma, where most frequently the diverticula are found. Literature refers to them as varying percentage of association diverticulosis-carcinoma between 2 to 8 percent. The increase of the frequency of neoplasms and diverticula in the same population classes may indicate common factors in their development. The study includes 1149 cases of colo-rectal neoplasms examined in the Department of Scienze Chirurgiche--University of Siena, from january 1981 to december 1993. The association of carcinomas and diverticula has been found in 8.96% of the cases (103 pts) and the tumours with stenosis in 59,2% of the cases. The colonoscopy is very important for a more precise differential diagnosis especially in occlusive forms, in which a multiple biopsy is indispensable. Referring to the data of literature, the authors consider that patients with symptomatic diverticular disease have a major general risk for cancer of the large intestine; the existence of certain common symptoms in either disease (especially the bleeding) may not exclude the presence of a tumor in patients with diverticular disease.

DNA fingerprinting of yeast strains by restriction enzyme analysis

Restriction endonuclease analysis was used as a new method to obtain genomic DNA fingerprints in yeast. Fifteen yeast strains belonging to the genera Saccharomyces and Zygosaccharomyces were examined. Restriction fragments obtained with ApaI or KspI endonucleases were separated by SDS-PAGE and silver-stained. Analysis of the fingerprints showed that restriction enzyme digestion of genomic DNA can be successfully applied to yeast, enabling the differentiation between strains belonging to different or to the same species or genera.

Effect of estradiol on endotoxin-induced changes in steroid hormone levels and lethality in male rats

We examined the effect of exogenous estradiol on the changes in serum steroid hormone levels induced by a nonlethal dose of Escherichia coli endotoxin in male rats and the deaths due to nonlethal and lethal doses of endotoxin. Injection of estradiol 5 min before a nonlethal dose of endotoxin changed the serum sex steroid hormone response of male rats to endotoxin. The serum estrogen concentrations of estradiol + endotoxin-treated rats decreased by 50% (P < 0.001), while those of the endotoxin-treated rats increased (2- to 5-fold). The serum androgen concentrations of estradiol + endotoxin-treated rats did not change significantly, while those of endotoxin-treated rats dropped to 30-40%, P < 0.001. Exogenous estradiol also appeared to influence the percentage of endotoxin-induced deaths in a dose-dependent manner. It reduced the number of deaths induced by nonlethal (2 mg/kg) dose of endotoxin but increased the number of deaths induced by a highly lethal dose (8 mg/kg). These results, together with the known relationships between estrogen and the immune response, suggest that estrogens affect the course of septic shock in a complex fashion and may have either protective or deleterious effect.

HPLC separation of toxic fraction components extracted from planktonic and benthic Cnidaria

HPLC separation of crude extract components derived from nematocysts and extranematocystic tissues of macroplanktonic jellyfish Aequorea aequorea and Rhizostoma pulmo and benthic sea-anemones Actinia equina and Anemonia sulcata was carried out by different columns. A satisfactory peak separation was obtained analyzing the toxin of Rhizostoma pulmo by cationic and C18 columns. Low molecular weight fragments were separated by C18 column and U.V. monitored varying pH values and obtaining the displacement of significant peaks. Clear differences between chromatographic plots concerning planktonic and benthic species was evidenced by anionic column; this result can point out a clear ecological analogy between species living in the same environment and a similar toxin biosynthesis, due to selective actions related to both the environment and the phylogenetic relationships; these organisms could have developed similar mechanisms useful to tackle the environment.

Lack of alteration in cardiac beta-adrenoceptor site concentration in rats treated with an adenylate cyclase-stimulating dose of endotoxin

In previous experiments on male rats we showed that 2 mg kg-1, intravenously, lipopolysaccharide from Escherichia coli, a sublethal nonhypotensive dose, induced circulating cardiodepressant activity, maximal alterations in steroid hormonal response, and myocardial adenylate cyclase hyperactivity 4 h later. The purpose of the present study was to investigate a possible relation between this adenylate cyclase hyperactivity and alterations in total ventricular beta-adrenoceptors. To this end, ventricular beta-adrenoceptor concentration and affinity were measured under the same conditions. Binding assays were performed using [3H]dihydroalprenolol. No significant change was observed in both parameters.

[Surgical treatment of neoplasms in geriatric patients]

The Authors report their experience in the surgical management of cancer in the aged (over 65 year old patients), during the period 1988-1992 at the Istituto Policattedra di Scienze Chirurgiche, University of Siena. They consider colon and rectum, breast, stomach, pancreas and biliary tract neoplasms in relation to site, staging, emergency or delayed surgical treatment, and early postoperative results. Finally, they outline the frequently encountered problems in treating old patients and the most appropriate surgical approach.

[Ischemic colitis localized in the right colon. A clinical case report]

Ischemic colitis shock-associated still is a not well-defined clinical entity. The authors describe symptoms, clinical course and treatment in a case recently observed. They outline the difficulties of preoperative diagnosis and the need of a not postponable surgical treatment due to shock and peritonitis.

Relationship between changes in serum estrone levels and outcome in human males with septic shock

The effect of septic shock on the production of estrogens, other steroid hormones, and gonadotropins in men was investigated. Two groups of male patients in the early septic shock were studied over 3 days following their admission to the Intensive Care Unit. Group I (n = 9) patients recovered and group II (n = 6) patients died. The simplified acute physiological score was 13.5 +/- 1.5 for group I and 21.2 +/- 2.3 for group II (P less than .05). In group I patients, estrogen levels (particularly E1) were high on day 1 and decreased progressively (day 1: 3,515 +/- 884 pmol/L, day 2: 2,450 +/- 292 pmol/L, and day 3: 1,043 +/- 255 pmol/L). In group II patients, estrone levels were as high as in group I on day 1, but increased throughout the 3 days (day 1: 3,250 +/- 1,200 pmol/L, day 2: 4,495 +/- 930 pmol/L, and day 3: 6,123 +/- 966 pmol/L). There were few changes in gonadotropins and other steroid hormones, except that the testosterone levels were below normal in both patient groups, while cortisol was elevated in group II. The changes in serum E1 may provide an accurate marker of individual outcome.

[Postoperative morbidity and mortality after surgical intervention for gastric carcinoma in advanced stage]

The paper reports the authors' experience in a group of 546 patients who underwent surgical treatment for gastric cancer from 1981 to 1988. Of 437 patients (80%) with advanced gastric cancer, 121 (28%) received palliative treatment and 316 (72%) were treated for curative purposes. Postoperative care was normal in 331 patients with a mean hospital stay of 11 days; various complications occurred in 106 patients with a mean hospital stay of 26 days. Overall operative mortality was 6% (27 patients). This study aimed to assess the main factor responsible for postoperative morbidity and mortality. Findings were compared to previously reported data and were shown to be similar.

Effect of the aromatase inhibitor, 4 hydroxyandrostenedione, on the endotoxin-induced changes in steroid hormones in male rats

The increase in circulating estrogen concentrations that follows injection of Escherichia coli endotoxin (Endo) may be due to increased aromatase activity. We have therefore analysed the effect of the aromatase inhibitor, 4 hydroxyandrostenedione (4OHA) on the steroid hormone response of male rats, particularly the dramatic increase in estrogens and decrease in androgens, induced by Endo. The concentrations of corticosterone (B), progesterone (P4), 17 alpha hydroxyprogesterone (17 alpha OHP4), androstenedione (delta 4), testosterone (T), estrone (E1) and estradiol (E2) were determined 2 hours after injection of increasing doses of 4OHA with and without Endo. The increase in serum estrogen concentrations and drop in serum androgen levels in response to Endo were blocked by a single dose of 4OHA. The effect of 4OHA appeared to be dose dependent. Low doses (30 mg/kg and 50 mg/kg) induced significant changes in the estrogen and androgen responses, but the high dose (100 mg/kg) blocked all changes in sex steroids induced by Endo. 4OHA did not alter the Endo-induced changes in other steroids.

[Plankton from the Riva Trigoso Bay(Ligurian Sea): presence of various trace elements]

Between March and June 1989 zooplankton and sea-water samples were taken in three different areas of Riva Trigoso Bay (eastern Ligurian Sea) every two weeks. The analysis of eight trace elements (Cd, Co, Cr, Cu, Fe, Ni, V, Zn) was conducted by means of a graphite furnace atomic absorption spectrophotometer (GFAAS). Biological material values resulted to be limited and quite homogeneous in all metal species thus with no apparent influence from sampling area or time. Observed concentrations (ng/g dry weight) ranged between 12 and 45 for Cd, 52 and 117 for Co, 30 and 71 for Cr, 428 and 1063 for Cu, 730 and 1440 for Fe, 265 and 512 for Ni, 361 and 510 for V, and 1403 and 2499 for Zn. Sea-water values confirmed the results of biological material thus testifying a particularly interesting environmental condition due to low contamination level detected in this part of the coast.

Unexpected hyperactivity of myocardial adenylate cyclase system in endotoxic male rats

Ventricle beta-adrenoceptors have been investigated and serum steroid levels determined in male rats injected intravenously with lipopolysaccharide from E. coli (LPS) under light anesthesia. Two series of doses were successively studied: 1) 2 and 3 mg.kg-1 and 2) 1 and 4 mg.kg-1, each including controls. The second series was carried out owing to the unexpected results of the first one. Homogeneity of the two series was tested. Experiments were performed at hr 4 after injection, a time previously tested to induce hormonal variations and release of a cardiodepressant factor (CDF) in serum. The results indicate that 2 mg.kg-1 LPS induced an increased activity of adenylate cyclase. The unexpectedly high response was dose-dependent since it was not found with the lowest or highest doses. The determination of serum steroid levels (progesterone, 17 alpha-hydroxyprogesterone, corticosterone, delta 4-androstenedione, testosterone, estrone, and estradiol) was used as a kind of marker of endotoxin activity. The results point out that the light anesthesia used for LPS injection delayed the hormonal response, when compared with results previously obtained with the same LPS dose (2 mg.kg-1) in unanesthetized rats. It can be inferred that the present data should usually appear at an earlier stage. It is suggested that an endotoxin-induced protein kinase C activation could be involved in the observed hyperactivity of adenylate cyclase and the hyperdynamic phase of septic shock.

[Antropyloric preservation in pancreatic excisions]

The authors report 11 consecutive partial or total pancreatectomies with preservation of the pylorus. They believe this technique is to be preferred because it allows a better digestion and reduces complication rate.