Role of pulsatility on particle dispersion in expiratory flows

Expiratory events, such as coughs, are often pulsatile in nature and result in vortical flow structures that transport respiratory particles. In this work, direct numerical simulation (DNS) of turbulent pulsatile jets, coupled with Lagrangian particle tracking of micron-sized droplets, is performed to investigate the role of secondary and tertiary expulsions on particle dispersion and penetration. Fully developed turbulence obtained from DNS of a turbulent pipe flow is provided at the jet orifice. The volumetric flow rate at the orifice is modulated in time according to a damped sine wave, thereby allowing for control of the number of pulses, duration, and peak amplitude. Thermodynamic effects, such as evaporation and buoyancy, are neglected in order to isolate the role of pulsatility on particle dispersion. The resulting vortex structures are analyzed for single-, two-, and three-pulse jets. The evolution of the particle cloud is then compared to existing single-pulse models. Particle dispersion and penetration of the entire cloud are found to be hindered by increased pulsatility. However, the penetration of particles emanating from a secondary or tertiary expulsion is enhanced due to acceleration downstream by vortex structures.

Breast cancer in European Union: an update of screening programmes as of March 2014 (review)

Breast cancer, a major cause of female morbidity and mortality, is a global health problem; 2008 data show an incidence of ~450,000 new cases and 140,000 deaths (mean incidence rate 70.7 and mortality rate 16.7, world age-standardized rate per 100,000 women) in European Union Member States. Incidence rates in Western Europe are among the highest in the world. We review the situation of BC screening programmes in European Union. Up to date information on active BC screening programmes was obtained by reviewing the literature and searching national health ministries and cancer service websites. Although BC screening programmes are in place in nearly all European Union countries there are still considerable differences in target population coverage and age and in the techniques deployed. Screening is a mainstay of early BC detection whose main weakness is the rate of participation of the target population. National policies and healthcare planning should aim at maximizing participation in controlled organized screening programmes by identifying and lowering any barriers to adhesion, also with a view to reducing healthcare costs.

Colorectal cancer prevention in Europe: burden of disease and status of screening programs

Colorectal cancer is a major public health challenge worldwide. In Europe it is the first malignancy in terms of incidence and the second in terms of mortality in both genders. Despite evidence indicating that removal of premalignant and early-stage cancer lesion scan greatly reduce mortality, remarkable differences are still found among countries both in terms of organized screening programs and of the tests used. In 2003 the European Council recommended that priority be given to activation of organized cancer screening programs, and various states have been making significant efforts to adopt effective prevention programs with international quality standards and centralizing screening organization and result evaluation. After a 2008 European Union report on the state of screening program, activation highlighted that little more than 50% (12/22) of Member States had colorectal cancer screening programs, Screening programs have been adopted or earlier pilot projects have been extended nationwide. This paper examines the state of activation and the screening strategies of colorectal cancer screening programs in EU States as of July 2013.

Handgrip impairment in Charcot-Marie-Tooth disease

AIM

Charcot-Marie-Tooth disease (CMT) is a genetic neuropathy causing muscle weakening in the feet, legs and hands, with consequent impairment of ambulation and handgrip. For fast clinical evaluation and rehabilitation management of handgrip deficits, a functional classification in 4 stages or levels of clinical severity, based on the loss of handgrip types from the finest to the roughest, has been recently proposed. The aim of this study is to evaluate the prevalence of each level of handgrip impairment in a wide population of patients affected with demyelinating and axonal CMT.

METHODS

Two-hundred and forty-eight non-operated hands were examined to evaluate if and how the pinch between the pulp of the thumb and the pulp of the second or third finger was made, starting from the palm-up position with the fingers abducted or, in case of impossibility to do so, if a lateral pinch or only a grasp was possible. Following to this observation, each hand was fitted in 1 of the 4 stages described in the above-mentioned classification and then the frequency of each stage was determined.

RESULTS

As a whole, 75.4% hands were at stage 1; 9.7 were at stage 2; 10.9% at stage 3; 4% at stage 4.

CONCLUSIONS

The results of this survey reveal that, in the majority of the CMT cases, handgrip is affected mildly so that only simple recommendations to prevent further muscle and joint damage are required; however, in more than 1 out 5 cases, the handrip impairment is quite severe and requires a detailed rehabilitative program with daily exercises, and, in a small number of cases, is so severe that independence in the daily living activities is lost or very reduced.

Hypophosphaturic mesenchymal tumor of the ethmoid associated with oncogenic osteomalacia

Oncogenic osteomalacia is an uncommon syndrome characterized by bone pain, proximal muscle weakness, hypophosphatemia, hyperphosphaturia, and a low plasma concentration of 1,25-dihydroxy-vitamin D. The disease affects both sexes at around 40 years of age, although it can sometimes affect children and adolescents. Generally, the syndrome is associated with a tumor, usually benign, of mesenchymal origin and is resolved after removal of the tumor; this syndrome can sometimes be associated with malignant tumors. These tumors seem to be histologically heterogeneous and are generally localized in soft tissues and bone. In this article, a case of oncogenic osteomalacia associated with a hypophosphaturic mesenchymal tumor of the ethmoid is reported in a 24-year-old man. After surgical and radical removal of the tumor, the patient noted a decrease in the clinical symptoms and signs.

A protocol for the treatment of mandibular condylar fractures

The authors suggest a protocol for the treatment of mandibular condylar fractures classified by fracture level: the condylar head, the condylar neck and subcondylar fractures. The protocol provides a guide to individualizing intervention according to the type of fracture, the patient's age, the degree of restriction of mandible movement and the possible presence of fractured condyle displacement, which is often associated with functional disorders. The age of the patient is a key factor in the choice of treatment. The therapeutic goal in adult patients differs from that in growing patients, since in children the condyle is a major growth center for the mandible. Management may be surgical or nonsurgical; surgical intervention may be conservative with or without immobilization with closed or open reduction and fixation.

Maxillofacial traumas

Craniofacial traumas often involve the orbital region. This report describes an unusual case of penetration of an object into the left upper oral vestibule up to the left medial-upper orbital wall. The object was an indicator switch. A multidisciplinary approach was necessary to make a correct diagnosis and to apply the best surgical treatment. The object was surgically removed, and rigid internal fixation was used to reconstruct the inferior and medial orbital walls. The aesthetic and functional results were good. One year later, the patient showed a slight enophthalmos with normal ocular motility.

[The issue of authorship and proliferation of scientific research]

In conducting scientific research, certain ethical standards must be applied, not only in the actual performance of the research, in particular the choice of appropriate methodology, but also in writing about science. Authorship is an important aspect of ethical standards in scientific writing. In this article, we discuss the benefits and drawbacks of the most universally recognised guidelines for scientific authorship (i.e., those of the Vancouver Convention), in an attempt to contribute to resolving the recent debate on their presumed inapplicability. In addition to possible solutions to this problem, we provide indications regarding the closely related problem of the proliferation of scientific publications, which affects publication bias and contributes to the confusion surrounding the Impact Factor. Regardless of the specific solution adopted, it must be stressed that writing about science is an ethical decision.

Surgical treatment of frontoethmoidal encephalocele: a case report

This study reports a patient affected by congenital frontoethmoidal encephalocele. The cause of this malformation is unknown. A preoperative selective diagnosis evaluation is necessary. The workup should include an accurate clinical examination associated with radiological study (two- and three-dimensional computed tomography, magnetic resonance imaging, etc). The aim of the surgical treatment is to restore the functional brain tissue in the cranial cavity, perform dural repair, correct bone lack and other associated facial malformations (hypertelorism, orbital dystopia, etc.). A multidisciplinary team approach is necessary to resolve the brain herniation and to correct splanchnocranium malformations frequently associated with encephalocele. Cranial flap with orbital osteotomies has been performed; this operation permits correction of the hypertelorism and of the orbital dystopia associated with this malformation. In bone reconstructions, miniplates have been used as fixation devices. In adults we generally use titanium, but resorbable devices are required in children because of growing tissues. A restoration of craniofacial malformations with good aesthetic and functional results is achieved with early surgery.

[Note on glycosaminoglycans]

Having briefly recalled the chemical structure of glycosamine glycans (GAG) and the therapeutic use of standard heparin at conventional doses (anticoagulant action) and at low dosage (antithrombotic action), the properties and therapeutic employment of low molecular weight heparins (LMWH) are illustrated, and their advantages and disadvantages compared to standard heparin are discussed. Subsequently, the characteristics of heparan sulfates and other GAGs of the vascular endothelium and their therapeutic properties are described. Finally, GAGs found in articular structures are also mentioned.

[Anesthesia in thymectomy. Experience with 115 cases]

The authors have conducted a retrospective study on 115 patients with myasthenia gravis undergoing transsternal or transcervical thymectomy at the Policlinico A. Gemelli of Rome in the period June 1984- to June 1991. A prolonged postoperative mechanical ventilation immediately and a few days following surgery was required respectively in 7 and 3 patients, while atelectasia and broncopneumonia have developed in 10 patients. No relationship could be established between the incidence of respiratory complications and factors such as preoperative symptomatology and treatment anesthetic agents, the surgical approach to the thymus and thymic pathology. However a significantly greater postoperative morbidity has been observed in the group of patients receiving suxametonium as compared to the patients receiving non-depolarizing muscle relaxants. Vecuronium and atracurium very frequently allowed ad adequate resumption of spontaneous respiration after anesthesia and made possible a safe early extubation of patients before leaving the operating room. The authors also stressed that all patients, irrespective of their clinical conditions, must be transferred after thymectomy. Oto the surgical ICU where anticholinesterase therapy can be safely restarted and cardiorespiratory status carefully monitored.

[Oncogenes: a ray of light on the genesis and therapy of cancer?]

The criteria that have led to the hypothesis according to which oncogenes play a role in the pathogenesis of cancer are briefly reviewed: "Certain genes normally present in cells in which they exert physiologic functions may become altered so as to induce cancer. Before acquiring carcinogenic properties, i.e. while they still exert their physiological function, these genes are referred to as proto-oncogenes; once they acquire their carcinogenic properties, they are called oncogenes". The importance modern techniques of molecular biology (genetic engineering and recombinant DNA) have had for the formulation of this hypothesis is stressed, as well as the involuntary contribution of retroviruses. The prospects are examined for therapeutic application that might derive from the oncogene hypothesis.

[Sociobiology and psychobiology: in the pantheon of science or in the basement of failures?]

The term sociobiology, coined by Wilson to describe the concept that human behaviour has a biological basis rooted in the genes, has aroused considerable controversy. The present report not only Wilson's hypothesis but takes it even further by putting forward the hypothesis that every human personality trait and resultant behavioural pattern is brought about by certain protein molecules, coded by the genes which activate special closed brain neuron circuits. The term "psychobiology" is suggested for this hypothesis, and "molecular personality code" for the whole complex of molecules mentioned above.