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This study aims to investigate the environmental fate of irbesartan when subjected to activated percarbonate treatment. The investigation delves into the formation of disinfection byproducts (DBPs) and evaluates their toxicity, and it seeks to draw comparisons with outcomes from treatment with sodium hypochlorite, already characterized in previous findings. The proposed treatment indicates the formation of at least 11 DBPs - eight identified for the first time - which have been isolated by various chromatographic techniques, identified by Nuclear Magnetic Resonance and Mass Spectrometry studies and for which a mechanism has been proposed to elucidate their formation. To evaluate irbesartan's biological impact during treatment with sodium percarbonate (SPC), a toxicity study of the DBPs was conducted using Daphnia magna, Aliivibrio fischeri, and Raphidocelis subcapitata, three model organisms. The ecotoxicity was evaluated using the Ecological Structure-Activity Relationships (ECOSAR) computer program and compared with experimental results. Compared to chlorination treatment, a lower mineralization percentage (-43 %) and amount of DBPs at least twice higher were observed. Toxicity assessment highlighted that DBPs formed during SPC treatment were more toxic than those from chlorination. ECOSAR predicted toxicity aligned with experimental findings. Additionally, the DBPs exhibited varying levels of toxicity, primarily attributable to the presence of aromatic and hydroxyl groups in their chemical structure, indicating that SPC treatment is not suitable for treatment of irbesartan polluted waters., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Cyanobacterial blooms, a natural phenomenon in freshwater ecosystems, have increased in frequency and severity due to climate change and eutrophication. Some cyanobacteria are able to produce harmful substances called cyanotoxins. These metabolites possess different chemical structures and action mechanisms representing a serious concern for human health and the environment. The most studied cyanotoxins belong to the group of microcystins which are potent hepatotoxins. Anabaenopeptins are another class of cyclic peptides produced by certain species of cyanobacteria, including Planktothrix spp. Despite limited knowledge regarding individual effects of anabaenopeptins on freshwater organisms, reports have identified in vivo toxicity in representatives of freshwater zooplankton by cyanobacterial extracts or mixtures containing anabaenopeptins. This study focused on the isolation and toxicity evaluation of the cyanotoxins produced in the 2022 Planktothrix rubescens bloom in Averno lake, Italy. The three main cyclic peptides have been isolated and identified by nuclear magnetic resonance (NMR) spectroscopy, mass spectrometry (MS) and optical analyses as anabaenopeptins A and B, and oscillamide Y. Ecotoxicological tests on the aquatic model organisms Daphnia magna (crustacean), Raphidocelis subcapitata (algae), and Aliivibrio fischeri (bacterium) revealed that anabaenopeptins A and B do not generate significant toxicity at environmentally relevant concentrations, being also found a stimulatory effect on R. subcapitata in the case of anabaenopeptin A. By contrast, oscillamide Y displayed toxicity. Ecological implications based on ECOSAR predictions align with experimental data. Moreover, long-term exposure bioassays on different green unicellular algae species showed that R. subcapitata was not significantly affected, while Scenedesmus obliquus and Chlorella vulgaris exhibited altered growth patterns. These results, together with the already-known background in literature, highlight the complexity of interactions between organisms and the tested compounds, which may be influenced by species-specific sensitivities, physiological differences, and modes of action, possibly affected by parameters like lipophilicity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The essential utilization of rare earth elements (REEs) for the production of several electronic devices is making the demand for them being increased all the time. This extensive use of these elements has also increased concern about human and environmental health. Previous studies have shown that REE levels are higher in environmental samples near mining sites, and they are highly possible to be transferred to biota. In this study, REE levels were determined in environmental samples collected from three abandoned mining sites of bauxite (Gargano, Otranto, and Spinazzola) in the region of Puglia, Southern Italy. The samples were digested and analyzed by two different techniques, Total X-Ray Fluorescence (TXRF) and Inductively Coupled Plasma - Mass Spectroscopy (ICP-MS) to investigate which technique is the most suitable for analysis of the REE content in samples from abandoned mining sites of bauxite. Only 6 REEs could be detected by TXRF, while all REEs were detected in all the samples by ICP-MS. Spinazzola is the richest site and Ce the most abundant REE in all three regions. REE levels are correlated between the soil and biota samples in many cases, although the calculation of the bioconcentration factor showed that REEs are not bioaccumulative. ICP-MS seems to be a more suitable technique for analysis of the whole REE content in environmental samples from abandoned mining sites of bauxite., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Multigenerational toxicity testing is a valuable tool for understanding the long-term effects of contaminants on aquatic organisms. This review focuses on the use of multigenerational tests with Daphnia, a widely used model organism in aquatic toxicological studies. The review highlights the importance of studying multiple generations to assess Daphnia spp. reproductive, growth, and physiological responses to various contaminants. We discuss the outcomes of multigenerational tests involving different contaminants, including nanoparticles, pesticides, and pharmaceuticals. The results reveal that multigenerational exposure can lead to transgenerational effects, where the impacts of contaminants are observed in subsequent generations even after the initial exposure has ceased. These transgenerational effects often manifest as reproduction, growth, and development alterations. Furthermore, we emphasize the need for standardized protocols in multigenerational testing to ensure comparability and reproducibility of results across studies. We also discuss the implications of multigenerational testing for ecological risk assessment, as it provides a more realistic representation of the long-term effects of contaminants on populations and ecosystems. Overall, this review highlights the significance of multigenerational tests with Daphnia in advancing our understanding of the ecological impacts of contaminants. Such tests provide valuable insights into the potential risks associated with long-term exposure to pollutants and contribute to the development of effective mitigation strategies for aquatic ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In recent years, sewage treatment plants did not effectively remove emerging water pollutants, leaving potential threats to human health and the environment. Advanced oxidation processes (AOPs) have emerged as a promising technology for the treatment of contaminated wastewater, and the addition of catalysts such as heavy metals has been shown to enhance their effectiveness. This review focuses on the use of rare earth elements (REEs) as catalysts in the AOP process for the degradation of organic pollutants. Cerium and La are the most studied REEs, and their mechanism of action is based on the oxygen vacancies and REE ion concentration in the catalysts. Metal oxide surfaces improve the decomposition of hydrogen peroxide to form hydroxide species, which degrade the organics. The review discusses the targets of AOPs, including pharmaceuticals, dyes, and other molecules such as alkaloids, herbicides, and phenols. The current state-of-the-art advances of REEs-based AOPs, including Fenton-like oxidation and photocatalytic oxidation, are also discussed, with an emphasis on their catalytic performance and mechanism. Additionally, factors affecting water chemistry, such as pH, temperature, dissolved oxygen, inorganic species, and natural organic matter, are analyzed. REEs have great potential for enhancing the removal of dangerous organics from aqueous solutions, and further research is needed to explore the photoFenton-like activity of REEs and their ideal implementation for wastewater treatment.

For many years, there has been a debate on the polluting loads affecting the Gulf of Naples, one of Italy's most spectacular and iconic landscape. The wide territory bordering the Gulf includes the Sarno river basin (SRB) managed by the Southern Apennines River Basin District Authority in the framework of Unit of Management Sarno (UoM-Sarno). The paper investigated the anthropogenic pressures and their spatial distribution in the UoM-Sarno, revealing as SRB represents a hotspot of pollution mainly due to the high population density and widespread hydro-demanding activities which are responsible of high organic and eutrophication loads. The pollution sources, variably distributed on the area, and potentially conveyed to the wastewater treatment plants (WWTPs) located into SRB, were estimated considering the WWTPs treatment capacity as well. Results revealed a holistic picture of UoM-Sarno area allowing to establish the priorities of the interventions aimed at safeguarding the coastal marine resources. In particular, 2590 tons BOD/year were directly discharged into the Gulf of Naples due to the missing of sewers, and other 10,600 tons BOD/year are potentially discharged in the Sarno river reaching the sea, considering the contribution of population, industrial activity, and livestock., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Buffelgrass ( Cenchrus ciliaris L.) is an invasive C4 perennial grass species that substantially reduces native plant diversity of the Sonoran Desert through fire promotion and resource competition. Broad-spectrum herbicides are essentially used for its control, but they have a negative environmental and ecological impact. Recently, phytotoxicity on C. ciliaris has been discovered for two metabolites produced in vitro by the phytopathogenic fungi Cochliobolus australiensis and Pyricularia grisea. They were identified as (10 S ,11 S )-(-)- epi -pyriculol and radicinin and resulted in being potential candidates for the development of bioherbicides for buffelgrass biocontrol. They have already shown promising results, but their ecotoxicological profiles and degradability have been poorly investigated. In this study, ecotoxicological tests against representative organisms from aquatic ecosystems ( Aliivibrio fischeri bacterium, Raphidocelis subcapitata alga, and Daphnia magna crustacean) revealed relatively low toxicity for these compounds, supporting further studies for their practical application. The stability of these metabolites in International Organization for Standardization (ISO) 8692:2012 culture medium under different temperatures and light conditions was also evaluated, revealing that 98.90% of radicinin degraded after 3 days in sunlight. Significant degradation percentages (59.51-73.82%) were also obtained at room temperature, 30 °C or under ultraviolet (254 nm) light exposure. On the other hand, (10 S ,11 S )- epi -pyriculol showed more stability under all the aforementioned conditions (49.26-65.32%). The sunlight treatment was also shown to be most effective for the degradation of this metabolite. These results suggest that radicinin could provide rapid degradability when used in agrochemical formulations, whereas (10 S ,11 S )- epi -pyriculol stands as a notably more stable compound.

Octocrylene is an organic sunscreen whose main action is to absorb UVB radiation and short UVA wavelengths; it is used in various cosmetic products in order to provide an adequate sun-protection factor or to protect the cosmetic formulations themselves from UV radiation. This filter is believed to be a possible endocrine disruptor and is also questioned due to its allergic and/or photoallergic potential. However, it continues to be widely used, and it has been found in various environments, not least those of swimming pools, where it is evidently released by consumers, to the point that it is now considered an emerging micropollutant. The present investigation presents the possible chemical fate of octocrylene in the typical chlorination conditions of wastewater or swimming pools. A total of 11 disinfection byproducts were identified, and 6 were identified for the first time, and separated by HPLC. These products were identified through careful mass spectrometry studies and 1D and 2D NMR experiments. A formation mechanism has been proposed that justifies the chemical structures of all of the compounds identified. The ecotoxicological assessment of octocrylene and their products was carried out by employing Phaeodactylum tricornutum , Brachionus plicatilis and Aliivibrio fischeri as bioindicators. The ecotoxicity results reveal that toxic byproducts might be generated during the oxidation process, increasing the potential risk to the marine environment.

The intensive human activities extensively contaminated water sources making its treatment a problem of paramount importance, especially with the increasing of global population and water scarcity. The application of natural coagulants has become a promising and environmentally friendly alternative to conventional ones. This study was aimed at evaluating the efficiency of four plant extracts namely Agave americana, Carpobrotus acinaciformis, Austrocylindropuntia subulate, and Senicio anteuphorbium as natural coagulants to remove Microcystis aeruginosa cyanobacterium from water. The effects of pH (4, 5, 6, 7, 8 9, and 10) and coagulant dose (5, 10, 15, 20, 25, and 30 mg/L) on the coagulation efficiency were investigated. Results showed that plant-based extracts exhibited high coagulant abilities significantly contributing to the removal of M. aeruginosa cells up to 80% on a case-by-case basis. The ecotoxicity (Daphnia magna, Aliivibrio fischeri, Raphidocelis subcapitata, and Sorghum saccharatum) was absent or presented very slight acute toxicity up to 12.5 mg/L being S. anteuphorbium the least toxic. PRACTITIONER POINTS: Nature-based plant extracts showed removal rates up to 80%. Lower pH and A. subulate and S. anteuphorbium were the most efficient coagulants Toxicity effects were plant extracts-based and dose function. A. subulate and S. anteuphorbium were the least toxic extracts., (© 2022 The Authors. Water Environment Research published by Wiley Periodicals LLC on behalf of Water Environment Federation.)

Color polymorphism is genetically controlled, and the process generating and maintaining morphs can affect speciation/extinction rates. Color badges are useful signals in intraspecific communication because they convey information about alternative strategies and can potentially decrease unnecessary conflicts among different color morphs. Competition and aggressive interactions among color morphs can contribute to polymorphism maintenance. This could lead to an uneven spatial distribution of morphs in a population because the local frequency of each morph establishes the intensity of the competition and the fitness of each male. We used a polymorphic lizard, Podarcis muralis, to assess if aggression varies among morphs under two contrasting hypotheses: a heteromorphic versus homomorphic aggression. We used laboratory mirror tests after lizard color manipulation, and we verified the consistency of results with an analysis of the spatial distribution of morphs in a wild population. Both the experiments confirmed that aggression is more common during homomorphic than heteromorphic contests. The adoption of alternative behavioral strategies that minimize risks and costs could facilitate the stable coexistence of the phenotypes and reduce competition. A bias in aggression would advantage rarer morph, which would suffer less harassment by common morphs obtaining a fitness advantage. This process would be negatively-frequency-dependent and would stabilize polymorphism, possibly contributing to sympatric speciation., (© 2021 Wiley Periodicals LLC.)

In recent years, many studies have reported the frequent detection of antihypertensive agents such as sartans (olmesartan, valsartan, irbesartan and candesartan) in the influents and effluents of wastewater treatment plants (WWTPs) and in the superficial waters of rivers and lakes in both Europe and North America. In this paper, the degradation pathway for candesartan (CAN) was investigated by simulating the chlorination process that is normally used to reduce microbial contamination in a WWTP. Twelve isolated degradation byproducts (DPs), four of which were isolated for the first time, were separated on a C-18 column by employing a gradient HPLC method, and their structures were identified by combining nuclear magnetic resonance and mass spectrometry and comparing the results with commercial standards. On the basis of these results, a mechanism of formation starting from the parent drug is proposed. The ecotoxicity of CAN and its DPs was studied by conducting a battery of ecotoxicity tests; bioassays were performed using Aliivibrio fischeri (bacterium), Daphnia magna (planktonic crustacean) and Raphidocelis subcapitata (alga). The ecotoxicity results shed new light on the increased toxicity of DPs compared with the parent compound.

The discovery of various sartans, which are among the most used antihypertensive drugs in the world, is increasingly frequent not only in wastewater but also in surface water and, in some cases, even in drinking or groundwater. In this paper, the degradation pathway of olmesartan acid, one of the most used sartans, was investigated by simulating the chlorination process normally used in a wastewater treatment plant to reduce similar emerging pollutants. The structures of nine isolated degradation byproducts (DPs), eight of which were isolated for the first time, were separated via chromatography column and HPLC methods, identified by combining nuclear magnetic resonance and mass spectrometry, and justified by a proposed mechanism of formation beginning from the parent drug. Ecotoxicity tests on olmesartan acid and its nine DPs showed that 50% of the investigated byproducts inhibited the target species Aliivibrio fischeri and Raphidocelis subcapitata , causing functional decreases of 18% and 53%, respectively.

Diclofenac (DCF) is the most widely prescribed non-steroidal anti-inflammatory drug in the world and it has been detected in drinking and surface waters. In this paper, the effect of chlorination process on DCF in aqueous solutions was investigated and the structures of 14 isolated degradation by-products (DPs), of which nine are new, have been determined from combining mass spectrometry and nuclear magnetic resonance data and justified by a proposed mechanism of formation beginning from the parent drug. Some degradation by-products show only one phenyl, others are dimers or trimers of the parental compound, which has undergone oxidative decarboxylation of the side chain and/or chlorination of this or one or both aromatic rings. Ecotoxicological bioassays evidenced the following sensitivities D. magna < R. subcapitata < A. fischeri. The isolated DPs (DP1-8, except for DP9) exhibited effects ≥ 50 % in the exposed microalgae and crustaceans showing toxicities mainly ranked from slight to acute., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Upper gastrointestinal bleeding (UGIB) is a cause of Emergency Department (ED) visits. Peptic ulcer secondary to H. pylori (HP) infection and/or to the use of NSAIDs is the most frequent cause. The aim of the study is to evaluate directly in the ED the prevalence of HP infection through Urea Breath test (UBT) in patients admitted to the ED for UGIB., Patients and Methods: We enrolled 87 patients (58M/29F) with a mean age of 63.8 + 11.7 yrs with an active UGIB who performed EGDS and UBT., Results: 34.4% of patients performing EGDS and UBT resulted positive to HP. Peptic ulcer was present in 20/30 (66.7%) of HP+ compared to 20/57 (35.1%) of HP- (p<0.001), and also gastritis and/or duodenitis were mostly present in HP+ (23.3% vs. 15.8%) (p<0.05). A biopsy was performed in only 31% of patients with a positive rate of 33.3%. In 78% we obtained a correspondence between UBT and biopsy results. Compared to biopsy result, we obtained for UBT a positive predictive value (PPV) of 71% and a negative predictive value (NPV) of 80%. Taking the UBT as a gold standard, we obtained for biopsies a PPV of 69% and a NPV of 85%., Conclusions: Our study confirms that the use of UBT directly in ED in patients with UGIB allows for a rapid, reliable and non-invasive diagnosis of HP infection as a causative agent for bleeding, thus permitting a right etiological treatment.

Drug abuse (cannabis, cocaine, opiates, and synthetic drugs) is an increasing phenomenon, especially in the younger population, thus leading to more cases of intoxication requiring evaluation in the emergency department and subsequent hospitalization. In 2017, 34.2% of students reported having used an illegal psychoactive substance in their lifetime, while 26% reported having done so over the past year. We made a review about the effectiveness of the role of the temporary observation unit in the emergency department to improve management of acute drugs intoxication. We checked medical literature from the last 10 years (2009-2019). The following electronic databases were systematically searched: MEDLINE-PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Then, a systematic review was carried out according to the Preferred Reporting Items for Systematic Review standards. Intoxicated patients usually display a favorable medical course, few diagnostic and therapeutic interventions, a short stay in the hospital, and, when hospitalization is needed, semi-intensive therapy is a feasible solution; therefore, intoxicated patients are ideal candidates for a temporary observation unit. The emergency department is very important to manage intoxicated patients; however, the hospitalization of these patients is often not necessary.

Recently, many studies highlighted the consistent finding of irbesartan in effluents from wastewater treatment plants (WWTPs) and in some rivers and lakes in both Europe and North America, suggesting that no >80% can be removed by specific treatments. The present investigation attempts to study the chemical fate of irbesartan in a simulated chlorination step, mimicking the conditions of a WWTP. A total of six disinfection by-products were identified, five were completely new, and separated on a C-18 column by employing a gradient HPLC method. Initially, a complete mass fragmentation pathway of the drug was established with the help of MS/TOF, and subsequently, the disinfection by-products were subjected to MS/TOF mass studies to obtain their mass and fragment pattern. The MS results helped to assign tentative structures to the disinfection products, which were verified through 1D and 2D NMR experiments. The chemical structures of the new compounds have been justified by a proposed mechanism of formation. A preliminary ecotoxicity assessment with the crustacean Daphnia magna showed that some of the identified by-products were up to 12-times more toxic than irbesartan., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Major bleeding is a life-threatening condition and a medical emergency with high mortality risk. It is often the complication of anticoagulant's intake. Anticoagulants are commonly used for the prevention and treatment of thrombotic events. The standard therapy with vitamin K antagonist (warfarin) has been frequently replaced by direct oral anticoagulants (DOACs). The latter agents (rivaroxaban, apixaban, edoxaban, dabigatran, and betrixaban) showed better efficacy and safety compared to standard warfarin treatment and they are recommended for the reduction of ischemic stroke. Literature data reported a high risk of gastrointestinal bleeding with DOACs, in particular with dabigatran and rivaroxaban. In case of life-threatening gastrointestinal bleeding, these patients could benefit from the use of reversal agents., Methods: We performed an electronic search on PUBMED of the literature concerning reversal agents for DOACs and gastrointestinal bleeding in the Emergency Department from 2004 to 2020., Aim: This review summarizes the current evidence about three reversal agents idarucizumab, andexanet alfa and ciraparantag, and the use of the first two in the emergency setting in patients with active major bleeding or who need urgent surgery which physicians indicate for a better management approach in order to increase patient's safety., Conclusion: Although these agents have been marketed for five years (idarucizumab) and two years (andexanet alfa) respectively, and despite guidelines considering antidotes as first-line agents in treating life-threatening hemorrhage when available, these antidotes seem to gain access very slowly in the clinical practice. Cost, logistical aspects and need for plasma level determination of DOAC for an accurate therapeutic use probably have an impact on this phenomenon.. An expert multidisciplinary bleeding team should be established so as to implement international guidelines based on local resources and organization., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

With our study, we searched the medical literature to find magnesium (Mg) correlation with Emergency situations or its use in Emergency Medicine. Our aim is to fill the gap that we find in our daily routine between Mg studies on its role in Emergency and the real conception that doctors have of it in medical practice. We searched the literature for terms as magnesium or magnesium sulphate, magnesium in emergency, eclampsia, arrhythmias, acute asthma exacerbation, magnesium, and pediatric population. After a thorough research, we divided our discoveries into chapters to sort out a large amount often discordant articles.

Objective: Most studies on atherosclerotic processes include peripheral arterial disease diagnosis only if patients report symptoms suggestive of peripheral arterial disease and/or an instrumental demonstration of lower limbs perfusion deficit is provided, rather than the sole presence of atherosclerotic lesions localized at lower limbs, this attitude leading to ignore early stages of the disease. To overcome these limitations, we have proposed a new ultrasonographic semiquantitative score to better identify all disease stages. The aim of this study is to compare ultrasonography versus ankle-brachial index in the association between peripheral arterial disease and cardiovascular risk factors., Patients and Methods: This cross-sectional observational study included subjects undergoing lower limbs evaluation through ultrasonography and ankle-brachial index determination because of symptoms suggestive of peripheral arterial disease or presence of known cardiovascular risk factors. Associations between ultrasonography and ankle-brachial index with cardiovascular risk factors were assessed by first fitting logistic regression models and then comparing the respective areas under the Receiver Operating Characteristic and 95% confidence intervals., Results: The areas under the Receiver Operating Characteristic for each cardiovascular risk factors were consistently larger in magnitude for ultrasonography compared with ankle-brachial index, this comparison being statistically significant for age, male gender, smoking status, hypertension, diabetes mellitus and previous cardiovascular events., Conclusions: Our study demonstrates that ultrasonography is a better method to screen peripheral arterial disease respect to ankle-brachial index in order to identify all disease stages. These findings are useful in particular when including peripheral arterial disease as organ damage marker in cardiovascular risk stratification.

Background & Aims: Diverticular Disease (DD) is a common clinical condition with a dramatic increasing of the prevalence among industrialized countries. Based on the most used classification, DD may be divided into asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease and complicated diverticular disease. Since recent studies pointed out the role of GUT microbiota imbalance in promoting diverticular formation and inflammation, we have designed a systematic review focusing on the possible role of probiotics in the management of this condition., Methods: According to PRISMA, we identified studies on DD patients treated with probiotics, by searching on Pubmed, Embase, Cochrane and ResearchGate., Results: 13 studies were included in this review based on our selection criteria: 3 double-blind randomized placebo-controlled, 6 open randomized, and 4 non-randomized open studies., Conclusion: This is the first systematic review providing an updated measure of evidence on the efficacy of probiotics in a different phase of DD. Even though the majority of studies are still preliminary, current data show a possible clinical application of certain probiotic strains in all stages of DD. Further investigation is then required to better understand when and how probiotics can be used in different phases of DD., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Diclofenac is the most widely prescribed non-steroidal anti-inflammatory drug worldwide. Data collected during the last 10 years reported a dose-duration dependent increasing of cardiovascular risk associated with the use of diclofenac, supporting the evidence of a close association with the degree of COX-2 inhibition achieved in vivo. Nevertheless, the amplitude of cardiovascular risk associated with the administration of diclofenac at low doses and for the short-term duration is still poorly defined. Indeed, data did not show a clear and strong increasing of the risk for daily doses of 75 and of 50 mg. Concerning duration, while the identification of a safe temporal window is less defined, some studies reported an absence or a very low risk when the exposure is shorter than 30 days. Today, new low-dosage diclofenac formulations are available, allowing to reduce the systemic exposure, the degree of COX-2 inhibition and possibly the risk of occurrence of cardiovascular events. This is the reason why those new formulations may represent the ideal drug for the management of pain in the emergency setting.

An 84-year-old woman, affected by Alzheimer's disease, presented to the emergency department with intense dyspnoea. Since ECG was showing T wave inversion in anterior leads and troponin-T was high, the patient was admitted to our unit with a diagnosis of anterior non-ST elevation myocardial infarction. However, the patient's medical history and a further review of the ECG led us to suspect a pulmonary embolism (PE) as a possible differential clinical diagnosis. We tested this alternative hypothesis: echocardiography as well as contrast-enhanced CT scan confirmed the diagnosis of PE. We describe these misleading ECG findings together with a brief discussion of electrocardiographical changes in pulmonary embolism.

The use of a short-stay observation unit (OBI) in a pediatric department has reduced the number of admissions. Significant cost savings and a better care for children and their families have been also achieved. During the year 2003 in our department 1759 children received OBI. 226 (12.8%) were then admitted. 1553 (87.2%) were discharged after a nine-hour mean stay. Descriptive statistics are used to outline the sample of patients and used treatments.

The activity of the pediatric emergency ward in 1999-2003 period is described. An increasing number of contacts was recorded. Most of them should be considered improper. An extra health-care information is required, specially directed to the foreign families, who recently settled in our town. A pediatric outpatient clinic for non-critical patient could cover Sundays and holidays, as in other italian centers.

Four cases of mesenteric cystic neoformations personally observed in the last years are reported. This pathology should not be underestimated, since not only does it present several problems regarding diagnosis and treatment, but a nosologic classification is also difficult to make. Since such cysts present with aspecific symptoms, a definite diagnosis cannot always be reached by a preliminary X-ray investigation, which may lead to various interpretations, but often requires a subsequent histologic examination of operative specimen.

The ovarian cysts are one of the most common affections for females. Besides non-neoplastic functional cysts (follicular or luteal) with relatively small sizes, the neoplastic types, generally benign and that can be ascribed to serous tumors, of 10-15 cm or even bigger should be included. Nowdays, these neoformations are diagnosed relatively early, before they become of big dimensions, even if often they present few symptoms. Then it seems to be interesting to report a case recently observed of an ovarian cyst of 35x45x50 cm and weighing 23 kg in 29-year-old woman.

A case of adenocarcinoma of the head of the pancreas in a patient with situs viscerum inversus totalis, an association described for the third time in literature, is reported. The possible coexistence of malformations of transposed organs and the specular anatomosurgical situation requires particular attention in the diagnosis and preoperative evaluation as well as a careful reorientation of the surgical perspective and a correct surgical conduct.

Consumptive coagulopathy resulting in a disseminated intravascular coagulation is most often seen in infectious diseases and hematologic malignancies. Solid tumors may be associated with disseminated intravascular coagulation that results in gangrene of the upper extremity. A case report of lower-extremity gangrene as the pathology for gastric carcinoma is presented. The need for a multidisciplinary approach to this clinical presentation is noted.

The authors observed symptoms relating to the existence of a phantom rectum, a phenomenon about which little is still known, in 233 cases (32.1%) in a series of 724 patients undergoing amputation of the abdomino perineal rectum due to malignant neoplasm. The genesis of this phenomenon is attributed to an abnormal reactivity of the cortical and thalamic projection areas with greater response to stimuli from the stump or aspecific visceral stimuli, or even stimuli from the adjacent cortical regions. The psychodynamic aspects linked to the patient's need to develop a different body awareness should not be underestimated; this has to integrate a new anatomic reality, such as colostomy in the place of the anorectum, entailing the relinquishment of the previous body scheme. Prevention and treatment of phantom rectum, which is painful in 27% of cases, is essential for a correct operating technique, adequate psychotherapeutic support, the patient's active participation in a reeducation programme for colostomy management. It should not be forgotten that painful phantom rectum, especially with late onset, may be diagnostically significant as an indicator of the recurrence of neoplastic pathology, sometimes allowing diagnosis to be anticipated by several months. This underlines the importance of carrying out a careful postoperative clinical, biohumoral and radiological control in these patients, including pelvic CT. In the authors' experience of 233 patients suffering from phantom rectum, it was possible to document the presence of neoplastic recidivation in 30 cases (12.8%) using pelvic CT. In these cases, symptoms appeared after a disease-free interval of 26.3 months (range 3-75 months), whereas the presence of phantom rectum without recidivation is usually described in the first 2 months after surgery.

Based upon ultrastructural findings and computed tomography, a presumptive diagnosis of feline primary ciliary dyskinesia was made in a 2.5-year-old cat. The cat demonstrated morphologic alterations in the ultrastructure of oviductal cilia. In the oviduct, axonemal abnormalities were detected in 132 (20%) of 660 cross-sectioned cilia. The main ultrastructural ciliary defects were a lack of central microtubules, transposition of peripheral doublets to the center of the axoneme, supernumerary microtubules, and morphologic abnormalities of peripheral doublets. Computed tomography of the chest was consistent with early lesions of bronchiectasis, suggesting chronic stagnation of respiratory secretions, attributed to abnormal function of respiratory cilia. Specifically, the cranial branches of the cat's bronchi were wider and thicker than those of five healthy controls. Foci of pleural thickening and interstitial enlargement were also observed.