Identification of the safe(r) by design alternatives for nanosilver-enabled wound dressings

The use of silver nanoparticles (NPs) in medical devices is constantly increasing due to their excellent antimicrobial properties. In wound dressings, Ag NPs are commonly added in large excess to exert a long-term and constant antimicrobial effect, provoking an instantaneous release of Ag ions during their use or the persistence of unused NPs in the wound dressing that can cause a release of Ag during the end-of-life of the product. For this reason, a Safe-by-Design procedure has been developed to reduce potential environmental risks while optimizing functionality and costs of wound dressings containing Ag NPs. The SbD procedure is based on ad-hoc criteria (e.g., mechanical strength, antibacterial effect, leaching of Ag from the product immersed in environmental media) and permits to identify the best one among five pre-market alternatives. A ranking of the SbD alternatives was obtained and the safer solution was selected based on the selected SbD criteria. The SbD framework was also applied to commercial wound dressings to compare the SbD alternatives with products already on the market. The iterative procedure permitted to exclude one of the alternatives (based on its low mechanical strength) and proved to be an effective approach that can be replicated to support the ranking, prioritisation, and selection of the most promising options early in the innovation process of nano-enabled medical devices as well as to encourage the production of medical devices safer for the environment.

Synergistic effect of sericin and keratin in gelatin based nanofibers for in vitro applications

Protein-based nanomaterials are gaining growing interest in biomedical field. The present paper evaluates the physico-chemical properties of electrospun nanofibers resulting from the combination of gelatin with keratin (from wool) and sericin (from silk) to validate their use for in vitro interaction studies. We demonstrated that that presence of sericin influences the fiber morphology at macroscopic level - i.e., wide diameter distributions by SEM and image analysis - with effects on chemical - i.e., a decrease of hydrogen bonds of NH groups verified by infrared spectroscopy - and thermal behavior of electrospun nanofibers, in comparison with gelatin-based ones. Moreover, we verified that sericin, in combination with keratin macromolecules, can amplify the biochemical signal of gelatin, improving the in-vitro stability of gelatin-based nanofibers. In vitro results confirm a synergistic effect of sericin and keratin on human Mesenchymal Stem Cells (hMSC) proliferation - increase over 50% respect to other types - associated to the enhancement of in vitro stability directly ascribable to the peculiar physical interaction among the proteins. These findings suggest the use of sericin/keratin/gelatin enriched electrospun fibers as nanostructured platforms for interface tissue engineering.

Engineering of keratin functionality for the realization of bendable all-biopolymeric micro-electrode array as humidity sensor

The technological quest for flexible devices to be interfaced with the biological world has driven the recent reinvention of bioderived polymers as multifunctional active and passive constituent elements for electronic and photonic devices to use in the biomedical field. Keratin is one of the most important structural proteins in nature to be used as biomaterial platform in view of the recently reported advances in the extraction and processing from hair and wool fibers. In this article we report for the first time the simultaneous use of naturally extracted keratin as both active ionic electrolyte for water ions sensing and as bendable and insoluble substrate into the same multielectrode array-based device. We implemented the multifunctional system exclusively made by keratin as a bendable sensor for monitoring the humidity flow. The enhancement of the functional and structural properties of keratin such as bendability and insolubility were obtained by unprecedented selective chemical doping. The mechanisms at the basis of the sensing of humidity in the device were investigated by cyclic voltammetry and rationalized by reversible binding and extraction of water ions from the volume of the keratin active layer, while the figures of merit of the biopolymer such as the ionic conductivity and relaxation time were determined by means of electrical impedance and dielectric relaxation spectroscopy. A reliable linear correlation between the controlled-humidity level and the amperometric output signal together with the assessment on measure variance are demonstrated. Collectively, the fine-tuned ionic-electrical characterization and the validation in controlled conditions of the free-standing insoluble all-keratin made microelectrode array ionic sensor pave the way for the effective use of keratin biopolymer in wearable or edible electronics where conformability, reliability and biocompatibility are key-enabling features.

Hodgkin's Disease Developing in A Patient with Angioimmunoblastic Lymphadenopathy with Dysproteinemia - A Case Report

The case of a woman presenting the clinical and pathologic phenomena of angioimmunoblastic lymphadenopathy (AILD) with dysproteinemia is reported. The patient developed lesions in the lymph nodes, skin, lungs, liver and spleen, and her response to steroid and cyclophosphamide therapy was poor. At autopsy, microscopic findings in the mediastinal and abdominal lymph nodes were consistent with the diagnosis of Hodgkin's disease. Whereas the development of immunoblastic lymphoma is frequent in AILD, Hodgkin's disease is far less common. It is argued that malignant lymphoma in AILD may be the consequence of chronically depressed lymphocyte functions.

Study on the structure and properties of wool keratin regenerated from formic acid

Structural characteristics of keratin regenerated from water (KW) and from formic (KF) acid solutions were compared. Amino acid composition and molecular weight distribution of KW and KF samples were studied by high performance liquid chromatography (HPLC) and SDS-PAGE electrophoresis. Turbidity measurement showed that keratin dissolved in formic acid forms transparent and stable solutions and no flocculation occurs. In addition, because of its good solvation properties, studied by viscosity measurements, formic acid can be used as a co-solvent to prepare keratin-based blend solutions. Structural studies carried out by X-ray diffraction (XRD), Fourier transform infrared (FT-IR) and near infrared (NIR) suggest that formic acid stabilizes the beta-sheet structure. Thermogravimetric analysis (TGA) reveals a higher thermal stability of keratin regenerated from formic acid with respect to keratin regenerated from water.

[Recurrent intraparenchimal haemorrhages in a patient with cerebral amyloidotic angiopathy: description of one autopsy case]

Cerebral amyloidotic angiopathy represents the most frequent cause of lobar haematoma in young patients and represents 5-10% of the non-traumatic cerebral haemorrhages. In the present work, we describe one autoptic case of recurrent cerebral haemorrhages in a 58-year-old woman. Macroscopically in the brain multiple haemorragic areas were present in the right frontal pole, right frontal and temporo-parietal lobes with homolateral ventricular inundation. The histological, histochemical, immunohistochemical, ultrastructural and biomolecular investigations confirmed the presence of amyloid deposits in the middle-size and little-size cerebral arteries. We report, moreover, a novel mutation (Leu705Val) within the Abeta sequence of a AbetaPP in a family with autosomal dominant, recurrent intracerebral hemorrhages beginning in the sixth decade of life.

[The use of a computerised system in the reading of cytological cervicovaginals smears during programming of regional screening (one year of experience using the autopap system)]

From january to december 2001 n. 23.940 conventional Pap smears were consecuetively processed by the Autopap System. All these slides classified by AutoPap as "review" were subjected to a conventional reading by cytotechnologist using FOV areas selected by AUTOPAP and classified according to the BETHESDA System. All smears with high grade lesions were submitted to surgical biopsy and histologic diagnoses. 10%of those slides which were classified as No Further Review underwent a rescreening. Objective of our study was assess if a computerised reading of conventional cervicovaginal smears could really help manual screening, and to verify if the rank in "quintiles" given by the system to identify the lesions, correlates to the grade of morphological atypia found during manual revision. The accuracy of the results selected in the FOV areas for the manual guided revision was high. The AUTOPAP System selected as No Further Review mostly slides within normal limits, and no severe abnormalities (HSIL) were categorised by device as No Further Review. We also noted an effective reduction in the reading time: (6 minutes per smears by using the AUTOPAP compared to the 10 minutes per smears during manual conventional reading). If this date is summed up to 22% of all the smears classified as "No Further Review" (therefore it is not necessary to undergo a revision) a real redecution of the work load could be obtained.

[Benchmarking in pathological anatomy]

Data from five different Institution of Pathological Anatomy Hospital Services are presented in order to show one (the benchmark) of the multiple existing ways to approach the budget problem and the macroeconomic management of our Services. The aim of this work is not to show the "best" way to work in terms of cost-efficacy but only a methods to compare our results with others. Nevertheless from this study is possible also to make some considerations about medical and technical workload in different services with different habits.

[Comparative analysis of various biochemical and immunohistochemical methods for evaluating hormone receptors in breast carcinoma]

The aim of this study was to compare the grade of concordance between three methods to evaluate and to quantify the expression of estrogen and progesterone receptors in 180 cases of breast cancer. The methods compared were dextran-coated charcoal (DCC) method, immunochemical analysis (ICA), and immunohistochemistry (IHC). The grades of concordance are so summarized: (1) 77.8% for estrogen receptors (ER) and progesterone receptors (PgR) with DCC and ICA methods (r = 0.53 and r = 0.64, respectively); (2) 83.3% for ER (r = 0.53) and 75.6% for PgR (r = 0.64) with DCC and IHC methods; (3) 87.8% for ER (r = 0.98) and 86.7% for PgR (r = 0.99) with ICA and IHC methods. Nowadays, the technique carried out on tissue sections provides the most reliable information. The IHC method performed on formalin-fixed and paraffin-embedded tissue is preferred in laboratories with a high work load because it is easy and inexpensive and can be automated.

[What posttreatment monitoring in Whipple's disease? A case report]

The authors--which publish an overview about Whipple's disease in this issue, pages 609-611--report the case of a 67-year-old man admitted to the hospital because of migratory arthralgia, low-grade fever, lymphadenopathy, diarrhea, and impaired intestinal absorption. The microscopical examination of the intestinal mucosa showed an infiltration of the lamina propria by foamy PAS-positive macrophages. The patient was treated with antibiotics for 1 year and obtained clinical remission. The authors discuss if it is opportune, in subjects with this disease, to repeat the small-bowel biopsies at the end of the antibiotic treatment in absence of clinical manifestations of relapse or not.

[Sudden death during a game of soccer in a young adolescent with a myocardial muscle bridge]

The case of a young adolescent who suffered a sudden death while playing soccer is described. At necropsy a long intramyocardial segment of the obtuse marginal branch of the left coronary artery was found, with fresh ischemic damage in the surrounding myocardium. We comment about negativity of the tests the boy had undertaken because of a single syncopal episode he suffered in similar circumstances. Those tests included two 24-hour Holter monitorings, a maximal electrocardiographic stress-test and an electrophysiologic study. In no occasion did he complain of angina pectoris.

[Bladder hemangioma. Presentation of a case and review of the literature]

The Authors report a case of hemangioma of the bladder, probable relapse of a similar neoplasia treated with endoscopic diathermy 28 years before, in a 34 year old patient. The clinical presentation, the localization, the subject's age, the therapy and the lesion's histological type recall the main features of this neoplasia. Contrary to all traditional concepts, the diagnosis was made after a biopsy, with no particular problems occurring during the examination. The localization in the bladder dome allowed a good surgical exeresis in a healthy tissue causing a further relapse to be unlikely despite the muscular invasion of the neoplasia.

[Lymphangioma of the spleen. Apropos of 2 cases]

On the basis of two observed cases and a review of the literature, the extreme rarity of cystic lymphangioma of the spleen is pointed out. The presumed pathogenesis of the condition is described as are its greater frequency among the young, the possibility of dangerous complications and its non-malignity. The superiority of non-invasive instrumental diagnosis (echotomography and CAT) over traditional techniques is reported. Finally splenectomy is identified as the therapy of choice.

[Case of stenosing carcinoid tumor of the terminal ileum associated with gallbladder empyema with perforation]

The Authors report a case of stenosant carcinoid tumour of terminal ileum joined to biliary peritonitis due to perforation of gall-bladder empyema. After dealing the carcinoid and syndrome thereof, in the light of the study of literature, they show the case with some retrospective remarks, and frame it in the grolp of "little syndrome" carcinoid tumours.

Cytologic diagnosis of primary pulmonary actinomycosis: report of two cases

Two cases of primary pulmonary actinomycosis had a radiologic and clinical picture of malignancy. The cases were diagnosed by microscopic examination of sputum that had been embedded in paraffin. The sputum samples were sent to the cytology laboratory for screening for neoplastic cells, and colonies of Actinomyces were seen in all samples. The authors emphasize the difficulties that can be encountered by the cytopathologist in identifying classic actinomycotic colonies in debris.

[Cytospectrophotometry in the grading of malignant breast tumors]

The nuclear DNA content of neoplastic cell was measured in 30 cases of carcinomas of the human breast. The normal lymphocyte was used as a reference for the DNA value corresponding to a diploid number of chromosomes. Samples from the same cases were embedded in paraffin and stained with haematoxylin and eosin. The nuclear DNA content is compared with the histological malignancy grading following Bloom and Richardson.