P19 ECHOGRAPHIC EVALUATION OF INFERIOR VENA CAVA AND FLUID CHALLENGE RESPONSE IN PAROXYSMAL ATRIAL FIBRILLATION: A PRELIMINARY STUDY

Introduction

Volume depletion can trigger atrial fibrillation through the alteration of the balance of autonomic tone. Hemodynamic response to crystalloid infusion has never been investigated in Paroxysmal AF patients. In this pilot study we have evaluated volume expansion response using Doppler echocardiogaphy in a group of patients coming to our Emergency Department because of symptomatic paroxysmal AF.

Methods

In a group of consecutive Paroxysmal AF patients we performed a comprehensive echocardiographic examination including Vena Cava diameters and inspiratory collapse rate (from bidimensional subxiphoid view) and including Left Ventricular Outflow time–velocity integral (as mean value of 10 consecutive cardiac cycles). Those with mitral, aortic or tricuspid regrgitation of grade higher than 2+/4+, mitral stenosis, prosthethic mitral valve, FE < 55%, estimated sPAP higher than 40 mmHg were excluded. Thus we selected 13 patients (mean age 67,25 years, range 34–83). Time–velocity integral of LVOT was re–evaluated after intravenous infusion of 500 cc of normal saline in 10 minutes. An increase of at least 10% of LVOT time–velocity integral from baseline was considered as positive response to volume challenge, as stated in previous studies (1,2).

Results

Fluid challenge showed positive response in 7/13 patients. From ROC curve analysis an inspiratory diameter of 9,5 mm or a respiratory collapse of 52% or more both had a 75% sensitivity for volume challenge responsiveness.

Conclusion

Accounting for small sample size this preliminary work suggests that non invasive bedside parameters easy to evaluate can guide Paroxysmal AF management with crysalloid infusion on top of standard therapy. 1. Preau S et al Crit Care Med 2016; 45: e290–7 2. Bortolotti P et al Ann Intensive Care 2018; 8: 79

Recent results for the one-proton transfer reaction in the 18O+48Ti collision at 275 MeV

The 18O+48Ti reaction was studied at the energy of 275 MeV for the first time under the NUMEN and NURE experimental campaigns with the aim to investigate the complete net of reaction channels potentially involved in the 48Ca→48Ti double charge exchange transition. Such a transition is of great interest because of its relevance to the extraction of 48Ca→48Ti double beta decay nuclear matrix element. The relevant experiment was carried out at the MAGNEX facility of INFN-LNS in Catania. Angular distribution measurements for the various reaction products were performed by using the MAGNEX large acceptance magnetic spectrometer. The present contribution is focused on the analysis of the one-proton transfer channel with emphasis on the particle identification technique and the estimation of background contaminations.

Study of the 4He(4He,4He)4He* inelastic scattering at the MAGNEX facility

The 4He(4He,4He)4He* inelastic scattering was revisited in a new coincidence measurement at the MAGNEX facility of Istituto Nazionale di Fisica Nucleare – Laboratori Nazionali del Sud. The 4He + 4He → 4He + 4He* → 4He + 3H + 1H and 4He + 4He → 4He + 4He* → 4He + 3He + n reactions were measured simultaneously by detecting the 4He particles at the MAGNEX magnetic spectrometer in coincidence with the 3H and 3He at the OSCAR silicon telescope. The main concept of the experiment is described and the data reduction strategy is reported.

Estimation of neutron and γ-rays flux at the MAGNEX facility via FLUKA simulations

Simulations for estimating the neutron and γ-rays radiation background in the forthcoming NUMEN experiments at the upgraded MAGNEX facility were performed with the simulation package FLUKA. Three main radiation sources were considered in our simulations namely, the beam-target interaction, the moderation of the beam particles inside the beam dump and a hypothetical 10W loss in the beam intensity during the beam transport. In the present contribution, the results of this preliminary analysis are presented and discussed.

Study of the reaction 70Zn (15 MeV/nucleon) + 64Ni with the MAGNEX spectrometer for the production of neutron-rich isotopes

We describe our efforts to study the production of neutron-rich isotopes from peripheral reactions of medium-mass heavy ions with the MAGNEX spectrometer at the INFN-LNS in Catania, Italy. Experimental data were obtained for the 70Zn+64Ni reaction at 15 MeV/nucleon. For the analysis of the data, we developed a new procedure for the reconstruction of both the atomic number Z and the ionic charge q of the ions, which is then followed by the identification of the mass. Preliminary results and the analysis plan will be discussed.

First record of Dosima fascicularis (Ellis amp; Solander, 1786) (Crustacea, Cirripedia) in the Strait of Messina (Central Mediterranean Sea)

Four specimens of Dosima fascicularis were collected from the Strait of Messina (Central Mediterranean Basin), representing the first record of the species from this locality, the second from Italian waters, and the most eastern indication of the species in the Mediterranean Sea.

Expression of ghrelin and leptin in the chemosensory system of adult zebrafish

Numerous data show that the chemosensory system seems to be modulated by changes in the circulating levels of different molecules such as ghrelin, orexin, leptin, NPY, CCK. The chemosensory system of the zebrafish is represented by the taste buds (skin, oral and oropharyngeal), the olfactory rosette and the solitary chemosensorial cells (SCCs). The purpose of our study was to analyze the distribution of two peripheral hormones such as ghrelin and leptin in the chemosensory organs of the zebrafish. Our results demonstrated the presence of immunoreaction for all antibodies used in the zebrafish chemosensory organs even if with different distribution. In particular, IR was observed for ghrelin in the olfactory rosette while IR for leptin was found in the olfactory rosette, in the skin and oropharyngeal taste buds and in the gills. Both these hormones were detected in the intestine, used as a control.

Study of continuum excitation by light weakly bound projectiles on proton target

Elastic scattering and breakup angular distribution measurements for the systems 6,7Li + p were performed at the MAGNEX facility of the Istituto Nazionale di Fisica Nucleare-Laboratori Nazionali del Sud (INFN-LNS) in Catania, in the energy range of (2.3–5.4)AMeV. The breakup channel was identified and quantified adopting the algorithm MULTIP.Within this algorithm which is a Monte Carlo simulation code, the history of the breakup fragments can be tagged from the rest frame of the decay nucleus itself to the laboratory frame. Angular distribution data of both elastic scattering and breakup were analyzed under the same theoretical model and the influence of continuum on the elastic channel was investigated.

The nuclear matrix elements of 0νββ decay and the NUMEN project at INFN-LNS

The goal of NUMEN project is to access experimentally driven information on Nuclear Matrix Elements (NME) involved in the neutrinoless double beta decay (0νββ), by high-accuracy measurements of the cross sections of Heavy Ion (HI) induced Double Charge Exchange (DCE) reactions. The knowledge of the nuclear matrix elements is crucial to infer the neutrino average masses from the possible measurement of the half-life of 00νββ decay and to compare experiments on different isotopes. In particular, the (18O, 18Ne) and (20Ne, 20O) reactions are performed as tools for β+β+ and β-β- decays, respectively. The experiments are performed at INFN - Laboratory Nazionali del Sud (LNS) in Catania using the Superconducting Cyclotron (CS) to accelerate the beams and the MAGNEX magnetic spectrometer to detect the reaction products. The measured cross sections are very low, limiting the present exploration to few selected isotopes of interest in the context of typically low-yield experimental runs. In order to make feasible a systematic study of all the candidate nuclei, a major upgrade of the LNS facility is foreseen to increase the experimental yield of about two orders of magnitude. To this purpose, frontier technologies are going to be developed for both the accelerator and the detection systems. In parallel, advanced theoretical models will be developed to extract the nuclear structure information from the measured cross sections.

The α-decay of the Hoyle state in 12C: a new high-precision investigation

The αdecay path of the Hoyle state in 12C (Ex = 7:654MeV) represents one ofthe most challenging questions of modern nuclear physics. Its knowledge can help in theunderstanding of cluster configurations in light nuclei and the possible existence of Bose-Einstein condensates in nuclei. In stars, it is involved in the so-called 3αprocess, wherethe 12C nucleosynthesis occurs. We studied the 14N(d; α2)12C(7:654) reaction at 10:5MeVincident energy to probe its direct decay component. We found, with a precision higherof a factor 5 than any other previous experiment, an almost total absence of direct decaysby-passing the ground state of 8Be. From our analysis, a new upper limit of such decayis found at 0:043% (95% C.L.). Astrophysical 3α process reaction rate calculations haveto be accordingly revised.

Anisakis spp. larvae in three mesopelagic and bathypelagic fish species of the central Mediterranean Sea

In this work 437 fish samples of species belonging to the families Myctophidae (Electrona risso and Diaphus metopoclampus) and Phosichthyidae (Vinciguerria attenuata) were examined for the presence of Anisakidae larvae. The study was performed with fishes in the central Mediterranean Sea, particularly in the Strait of Sicily and in the Strait of Messina. The visual inspection and chloro-peptic analysis revealed the presence of nematode parasites with prevalence values between 2.9% in Electrona risso samples and 5.4% in Vinciguerria attenuata samples. A positive correlation was found between standard length (SL) and prevalence of infestation in D. metopoclampus samples (p<0.05). The larvae examined were morphologically ascribed, at genus level, to Anisakis morphotypes I and II and molecularly identified as Anisakis pegreffii, Anisakis ziphidarum and Anisakis physeteris, in 67%, 9% and 24% of the fish samples examined. Overall, A. pegreffii and A. ziphidarum larvae were isolated in 14 and 2 specimens of D. metopoclampus respectively, A. physeteris larvae were found in 3 E. risso and 2 V. attenuata. A positive correlation was found between standard length and prevalence of infestation in D. metopoclampus samples (p<0.05). First information is provided on the presence of Anisakis spp. larvae of the myctophid fish species E. risso, D. metopoclampus and V. attenuata from the Central Mediterranean. It is also confirmed the role of lanternfishes (Myctophidae) as paratenic hosts for Anisakis spp.

High-Precision Probe of the Fully Sequential Decay Width of the Hoyle State in ^{12}C

The decay path of the Hoyle state in ^{12}C (E_{x}=7.654  MeV) has been studied with the ^{14}N(d,α_{2})^{12}C(7.654) reaction induced at 10.5 MeV. High resolution invariant mass spectroscopy techniques have allowed us to unambiguously disentangle direct and sequential decays of the state passing through the ground state of ^{8}Be. Thanks to the almost total absence of background and the attained resolution, a fully sequential decay contribution to the width of the state has been observed. The direct decay width is negligible, with an upper limit of 0.043% (95% C.L.). The precision of this result is about a factor 5 higher than previous studies. This has significant implications on nuclear structure, as it provides constraints to 3α cluster model calculations, where higher precision limits are needed.

Investigation of the ^{10}Li shell inversion by neutron continuum transfer reaction

This Letter reports a study of the highly debated ^{10}Li structure through the d(^{9}Li,p)^{10}Li one-neutron transfer reaction at 100 MeV. The ^{10}Li energy spectrum is measured up to 4.6 MeV and angular distributions corresponding to different excitation energy regions are reported for the first time. The comparison between data and theoretical predictions, including pairing correlation effects, shows the existence of a p_{1/2} resonance at 0.45±0.03  MeV excitation energy, while no evidence for a significant s-wave contribution close to the threshold energy is observed. Moreover, two high-lying structures are populated at 1.5 and 2.9 MeV. The corresponding angular distributions suggest a significant s_{1/2} partial-wave contribution for the 1.5 MeV structure and a mixing of configurations at higher energy, with the d_{5/2} partial-wave contributing the most to the cross section.

The use of CEUS in the diagnosis of retinal/choroidal detachment and associated intraocular masses - preliminary investigation in patients with equivocal findings at conventional ultrasound

PURPOSE

To investigate whether contrast-enhanced ultrasound (CEUS) may help to diagnose retinal/choroidal detachment and may help to differentiate intraocular lumps in cases with equivocal features on conventional grayscale and Doppler modes.

MATERIALS AND METHODS

The institutional review board approved this retrospective study. The need for informed consent was waived. A computerized data search was performed in the database of our institution for patients with vitreous hemorrhage who underwent CEUS of the eye to assess retinal/choroidal detachment and/or associated masses. This process yielded a total of 31 patients (18 men, 13 women, age range: 39 - 88 years) in whom CEUS was performed because the findings on conventional grayscale and Doppler modes were equivocal. CEUS was performed using low acoustic power contrast-specific modes. A 2.4 - 4.8  mL bolus of SonoVue was injected, followed by a saline flush. All examinations were digitally recorded for retrospective analysis. Confirmation of CEUS findings was obtained at surgery (n = 20) or with binocular indirect fundoscopy performed after clearance of the ocular media (n = 11). Two readers with different levels of ultrasound experience independently reviewed the imaging features. A five-degree scale ranging from definitely absent (score 1) to definitely present (score 5) was used to assess the presence or absence of retinal/choroidal detachment on conventional ultrasound modes alone and with the addition of CEUS. ROC curve analysis was performed to assess the diagnostic accuracy of both methods. The inter-reader agreement was also evaluated. In patients with associated intraocular lumps, conventional Doppler modes and CEUS were used to differentiate non-tumor masses from tumor masses.

RESULTS

According to the reference standard, 13 patients had retinal detachment, 4 had choroidal detachment, and 3 had both retinal and choroidal detachment. There were 8 associated intraocular lumps (4 subretinal hemorrhages, 3 malignant melanomas, 1 metastasis). The inter-reader agreement was good (K = 0.644) and very good (K = 0.833) for conventional modes and CEUS, respectively. The diagnostic performance of CEUS was high for both readers (area ± standard error under the ROC curve: 0.966 ± 0.031 and 0.900 ± 0.055 for readers 1 and 2, respectively). There were 2 false-positive results and 1 false-negative result in patients with proliferative diabetic retinopathy. CEUS was effective in differentiating subretinal hemorrhage from hypovascular tumors.

CONCLUSION

CEUS can be used as a problem-solving technique when conventional ultrasound modes are not diagnostic for retinal/choroidal detachment and when intraocular lumps cannot be characterized as tumor or non-tumor masses on conventional modes. The evaluation of patients with proliferative diabetic retinopathy, however, may be problematic.

Oxidative stress, glutathione status, sirtuin and cellular stress response in type 2 diabetes

Oxidative stress has been suggested to play a main role in the pathogenesis of type 2 diabetes mellitus and its complications. As a consequence of this increased oxidative status a cellular adaptive response occurs requiring functional chaperones, antioxidant production and protein degradation. This study was designed to evaluate systemic oxidative stress and cellular stress response in patients suffering from type 2 diabetes and in age-matched healthy subjects. Systemic oxidative stress has been evaluated by measuring plasma reduced and oxidized glutathione, as well as pentosidine, protein carbonyls lipid oxidation products 4-hydroxy-2-nonenal and F2-isoprostanes in plasma, and lymphocytes, whereas the lymphocyte levels of the heat shock proteins (HSP) HO-1, Hsp72, Sirtuin-1, Sirtuin-2 and thioredoxin reductase-1 (TrxR-1) have been measured to evaluate the systemic cellular stress response. Plasma GSH/GSSG showed a significant decrease in type 2 diabetes as compared to control group, associated with increased pentosidine, F2-isoprostanes, carbonyls and HNE levels. In addition, lymphocyte levels of HO-1, Hsp70, Trx and TrxR-1 (P<0.05 and P<0.01) in diabetic patients were higher than in normal subjects, while sirtuin-1 and sirtuin-2 protein was significantly decreased (p<0.05). In conclusion, patients affected by type 2 diabetes are under condition of systemic oxidative stress and, although the relevance of downregulation in sirtuin signal has to be fully understood, however induction of HSPs and thioredoxin protein system represent a maintained response in counteracting systemic pro-oxidant status. This article is part of a Special Issue entitled: Antioxidants and Antioxidant Treatment in Disease.

Late cutaneous fistula after inguinal hernia repair without prosthesis

Late onset of cutaneous fistulas associated with inguinal hernia repair represents an extremely rare complication that occurs especially after affixing a prosthesis. The authors report a case of a patient developing this complication after a hernia repair (Shouldice's technique), emphasize that the fistula appeared after more than 12 years (the longest interval reported in the literature), and explain how it resolved only with the surgical removal of the suture used for hernia repair. The authors emphasize the aetiology of this complication and stress that it can occur even after a hernia repair without prosthesis.

The hormetic role of dietary antioxidants in free radical-related diseases

Regular consumption of cruciferous vegetables or spices is associated with a reduced incidence of cancer and reduction of markers for neurodegenerative damage. Furthermore, greater health benefit may be obtained from raw as opposed to cooked vegetables. Nutritional interventions, by increasing dietary intake of fruits and vegetables, can retard and even reverse age-related declines in brain function and cognitive performance. The mechanisms through which dietary supplementation with antioxidants may be useful to prevent free radical-related diseases is related to their ability to counteract toxic production of both reactive oxygen and nitrogen species, along with the up-regulation of vitagenes, such as members of the heat shock protein (Hsp) family heme oxygenase-1 and Hsp70. The most prominent dietary factor that affects the risk of many different chronic diseases is energy intake - excessive calorie intake increases the risk. Reducing energy intake by controlled caloric restriction or intermittent fasting increases lifespan and protects various tissues against diseases, in part, by hormetic mechanisms that increase cellular stress resistance. This biphasic dose-response relationship, referred to here as hormesis, display low-dose stimulation and a high-dose inhibition. Despite the current interest in hormesis by the toxicology community, quantitatively similar U-shaped dose responses have long been recognized by researchers to be involved with factors affecting memory, learning, and performance, as well as nutritional antioxidants and oxidative stress-mediated degenerative reactions. Dietary polyphenols present strong cytoprotective effects, however under uncontrolled nutritional supplementation gene induction effects and the interaction with detoxification responses can have negative consequences through the generation of more reactive and harmful intermediates.

Predisposing factors, clinical and microbiological aspects of bacterial keratitis: a clinical study

PURPOSE

To identify predisposing factors and to evaluate clinical and microbiological characteristics of bacterial keratitis.

MATERIALS AND METHODS

A retrospective analysis was performed on the charts of patients hospitalized for microbial keratitis and treated at the Department of Ophthalmology of the Policlinico Umberto I Hospital, Rome, Italy. The study was performed during a 42-month period. Risk factors, clinical and microbiological data were collected.

RESULTS

A total of 65 patients with bacterial keratitis were documented. Contact lens wear was the most common risk factor (46.1%). Trauma or a history of keratopathy was found in 18.5% and 15.4% of cases, respectively. An organism was identified in 62% of cases. 74% of all positive cultures involved gram negative bacteria. The most frequently cultured organism was Pseudomonas aeruginosa alone (72.2%) or in combination with other microorganisms (16.7%). Fifty-eight per cent of patients had visual acuity better than the level at admission, and 12% had very poor visual outcome.

CONCLUSIONS

Contact lens wear is the most important risk factor. The role of initial therapy for microbial keratitis remains important.

Generation of human cortical neurons from a new immortal fetal neural stem cell line

Isolation and expansion of neural stem cells (NSCs) of human origin are crucial for successful development of cell therapy approaches in neurodegenerative diseases. Different epigenetic and genetic immortalization strategies have been established for long-term maintenance and expansion of these cells in vitro. Here we report the generation of a new, clonal NSC (hc-NSC) line, derived from human fetal cortical tissue, based on v-myc immortalization. Using immunocytochemistry, we show that these cells retain the characteristics of NSCs after more than 50 passages. Under proliferation conditions, when supplemented with epidermal and basic fibroblast growth factors, the hc-NSCs expressed neural stem/progenitor cell markers like nestin, vimentin and Sox2. When growth factors were withdrawn, proliferation and expression of v-myc and telomerase were dramatically reduced, and the hc-NSCs differentiated into glia and neurons (mostly glutamatergic and GABAergic, as well as tyrosine hydroxylase-positive, presumably dopaminergic neurons). RT-PCR analysis showed that the hc-NSCs retained expression of Pax6, Emx2 and Neurogenin2, which are genes associated with regionalization and cell commitment in cortical precursors during brain development. Our data indicate that this hc-NSC line could be useful for exploring the potential of human NSCs to replace dead or damaged cortical cells in animal models of acute and chronic neurodegenerative diseases. Taking advantage of its clonality and homogeneity, this cell line will also be a valuable experimental tool to study the regulatory role of intrinsic and extrinsic factors in human NSC biology.

Unitubulotestis sardae (Trematoda: Didymozoidae) infection in Atlantic bonito Sarda sarda (Perciformes: Scomberomoridae) in the Ionian and Tyrrhenian Seas: histopathological and SEM investigations

Nematobothrinae are trematoda digenea that usually live in cysts in fish tissues. They have been reported in different teleost species although the host-parasite relationships remain to be elucidated. This report is aimed at analysing the presence of Unitubulotestis sardae in the Atlantic bonito (Sarda sarda) populations fished in the Straits of Messina. The histopathological change reported in literature in similar cases is an aneurisma verminosa saccata, whereas, in the specimens here described, we show neovascularisation and at the same time, hyperplasia of the gill epithelium, leading to the formation of a bistratified cystic wall. The SEM examination of the parasitic cysts gave us a better understanding of the surface microanatomical details of the cystic walls. The external surface appeared to be constituted by a pluristratified covering epithelium of the gill arch. The internal layer was constituted by a net of blood vessels richly anastomosed with those originating from the gill arch arteries. This could be in agreement with data reported by Grabda (1947) on the localisation of the juvenile stages of the parasite in this blood vessel, but the evolution in cysts formation does not show similarities with the formation of an aneurisma.

Immunohistochemical localization of BDNF-, TrkB- and TrkA-like proteins in the teleost lateral line system

The lateral line system, formed of both superficial (pit organs) and canal neuromasts, is one of the major mechanosensory systems in fish. It has always been assumed that this system depends on neurotrophins and their cognate Trk receptors for development and maintenance, as has been shown in other mechanosensitive systems of vertebrates. However, until nowthis issue has not been specifically addressed. In this study we used immunohistochemistry to investigate the occurrence and localization both of neurotrophins (NGF-, BDNF- and NT-3-like) and of Trk-like proteins (TrkA-, TrkB-, TrkC-like) in alevins of Salmo salar and S. trutta. All cells in the pit organs of S. salar displayed strong immunoreactivity for TrkB-like and BDNF-like, whereas they were restricted to the hair cells in S. trutta. The hair, supporting and mantle cells of S. salar, and the mantle cells of S. trutta, also expressed TrkA-like immunoreactivity. In the canal neuromasts BDNF-, TrkA- and TrkB-like proteins were present in all cells, without differences between species. NGF-, NT-3- and TrkC-like immunoreactivity were never detected. The present results suggest that mechanoreceptive hair cells, as well as supporting cells, in the lateral line system are under the control of the BDNF-TrkB-like complex, and probably of ligands of TrkA-like receptors.

Isolation and characterization of neural stem cells from the adult human olfactory bulb

We have recently isolated stem cells deriving from the olfactory bulbs of adult patients undergoing particularly invasive neurosurgery. After improving our experimental conditions, we have now obtained neural stem cells according to clonal analysis. The cells can be expanded, established in continuous cell lines and differentiated into the three classical neuronal phenotypes (neurons, astrocytes, and oligodendrocytes). Also, after exposition to leukemia inhibitory factor, we are able to improve the number of neurons, an ideal biological source for transplantation in various neurodegenerative disorders.

Querying temporal clinical databases with different time granularities: the GCH-OSQL language

There is a need for managing temporal clinical information given at different levels of granularity. Different time granularities are also needed in querying clinical databases. In this paper, we describe GCH-OSQL (Granular Clinical History--Object Structured Query Language), an object-oriented temporally-oriented extension of SQL. GCH-OSQL is based on an object-oriented temporal data model. It allows storage of clinical information at different and mixed granularities. GCH-OSQL deals with the valid time of clinical information. GCH-OSQL offers also a graphical user-interface. It guides different end users, from expert to naive, to formulate expressive and correct queries.