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Mycobacterium Fortuitum (M. Fortuitum) is a type of opportunistic pathogen commonly found in water/soil and belongs to the nontuberculosis mycobacteria (NTM) family. Prosthetic joint infection due to M. Fortuitum is extremely rare. We present a case of a 21-year-old female with an infection following a radical resection of the proximal tibia due to a parosteal osteosarcoma.

We found that 14.3% (15/105) of Amblyomma maculatum and 3.3% (10/299) of Dermacentor variabilis ticks collected at 3 high-use military training sites in west-central Kentucky and northern Tennessee, USA, were infected with Rickettsia parkeri and Rickettsia montanensis, respectively. These findings warrant regional increased public health awareness for rickettsial pathogens and disease.

Abstract: Chondrosarcoma is an aggressive bone tumor typically affecting older adults in the 6th and 7th decade. These tumors often present as painful masses in the pelvis, ribs, and long bones and have certain characteristic features on the imaging leading to the diagnosis. The occurrence of these tumors in the young adult population is a rare condition that is not well described. Often, they may be confused with benign counterparts, enchondroma or osteochondroma, which does not require any treatment and are very common. The aim of this case series was to analyze the patient presentation and radiographic image findings as well as surgical treatment and outcomes of ten young adults with chondrosarcoma over a three-year period. Overall, imaging of these tumors in young adults did not necessarily demonstrate all typical features of chondrosarcomas such as endosteal scalloping, calcifications, lobular growth, and high uptake on whole-body bone scans. One patient in the case series passed away from complications from dedifferentiated chondrosarcoma, and nine patients have recovered with no local recurrence., (Copyright © 2024 Copyright: © 2024 Journal of Cancer Research and Therapeutics.)

Degenerative arthritis of the first metatarsophalangeal joint, hallux rigidus, is the most common type of arthritis of the foot, affecting nearly 2.5% of the population over the age of 50. Hallux rigidus can be treated surgically with either Cheilectomy or Synthetic cartilage implant (SCI) hemiarthroplasty. The purpose of this study is to compare outcomes from a single institution on the treatment of hallux rigidus using cheilectomy and SCI hemiarthroplasty. Between 2012 and 2020, 49 patients underwent either a SCI (Polyvinyl alcohol hydrogels) hemiarthroplasty or Cheilectomy for the treatment of hallux rigidus. Functional scores were assessed pre and postoperatively using the American Orthopedic Foot and Ankle scoring System (AOFAS) and the Foot and Ankle Outcome Score survey (FAOS). Plantar and Dorsal range of motion was also assessed pre and postoperatively. Outcomes, complications, and any reoperations were recorded for all patients. Mean pre-op AOFAS for Cheilectomy and SCI were 49.6 and 54.8, respectively, compared to 85.3 and 89.7, respectively, after surgery (p value < 0.05). Mean pre-op Dorsal range of motion (ROM) for Cheilectomy and SCI were 24.0 and 26.0 degrees, respectively, compared to 38.0 and 42.6 degrees, respectively, after surgery (p value < 0.05). SCI hemiarthroplasty patients had higher AOFAS and dorsal ROM at the latest follow up (p value < 0.05). Synthetic cartilage implant (SCI) hemiarthroplasty and cheilectomy both offer promising results and remain viable treatment options to decrease pain, improve function, and maintain motion for hallux rigidus. SCI hemiarthroplasty may offer superior range of motion and functional outcomes than cheilectomy for hallux rigidus. LEVEL OF CLINICAL EVIDENCE: 3., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Telecommunications companies are constantly chasing continuous technological advances with their management methods of Operations & Maintenance (O&M) that still struggle to turn their eye toward innovation and simplification of processes. In a future that aims at fully fiber-optic networks, the objective of the research is to propose guidelines and provide data to support the Wholesale Operator for the definition of the acceptable attenuation threshold on the Passive Optical Network Fiber-To-The-Home (PON FTTH) infrastructure to determine the Service Level Agreements (SLA) to be contracted with Retail Operators. Following exceeding the threshold, the Retail Operator has the right to open a Trouble Ticket to request the resolution of the anomaly. Consequently, the definition of the attenuation threshold strongly affects the number of Trouble Tickets to be managed and the related costs the Wholesale Operator bears. This paper analyzes a specific case of the PON FTTH network of the Italian wholesale operator Open Fiber. The studied infrastructure, with a length of 11 km, allows a maximum attenuation of 37 dB without degrading the service. An economic model has been proposed to assess the cost impact of moving the attenuation threshold in the SLA., (© 2023. The Author(s).)

Theories across cognitive domains propose that anticipating upcoming sensory input supports information processing. In line with this view, prior findings indicate that adults and children anticipate upcoming words during real-time language processing, via such processes as prediction and priming. However, it is unclear if anticipatory processes are strictly an outcome of prior language development or are more entwined with language learning and development. We operationalized this theoretical question as whether developmental emergence of comprehension of lexical items occurs before or concurrently with the anticipation of these lexical items. To this end, we tested infants of ages 12, 15, 18, and 24 months (N = 67) on their abilities to comprehend and anticipate familiar nouns. In an eye-tracking task, infants viewed pairs of images and heard sentences with either informative words (e.g., eat) that allowed them to anticipate an upcoming noun (e.g., cookie), or uninformative words (e.g., see). Findings indicated that infants' comprehension and anticipation abilities are closely linked over developmental time and within individuals. Importantly, we do not find evidence for lexical comprehension in the absence of lexical anticipation. Thus, anticipatory processes are present early in infants' second year, suggesting they are a part of language development rather than solely an outcome of it., (© 2023 The Authors. Infancy published by Wiley Periodicals LLC on behalf of International Congress of Infant Studies.)

Background: The contamination of ambulances with pathogenic agents represents a potential threat for the public health, not only for common pathogens but also for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this project was to exploits the germicidal effect of the UVC radiation at 254 nm to sanitize the patient's compartment of ambulances with an advanced UltraViolet SANitizing System (UV-SAN) and assess its relevance for avoiding the spread of COVID-19 and other drug resistant pathogens., Methods: The system is equipped with UVC lamps that are activated when the ambulance compartment is empty and sanitize the environment in less than 15 min. An Ozone sensor continuously monitors the gas concentration, ensuring it does not exceed threshold value harmful for patients and operators' health. The system is relying on GNSS data and a satellite communication link, which allow to monitor and record traceability (when, where and what) of all the sanitation operations performed. This information is real-time monitored from a dedicated web-application., Results: UVC irradiation efficiently reduced SARS-CoV-2 virus titer (>99.99%), on inanimate surfaces such as plastic, stainless steel or rubber, with doses ranging from 5.5 to 24.8 mJ/cm 2 and the UV-SAN system is effective against multi drug resistant (MDR) bacteria up to >99.99%, after 10 to 30 min of irradiation., Conclusions: UV-SAN can provide rapid, efficient and sustainable sanitization procedures of ambulances.

Integrase-defective lentiviral vectors (IDLVs) represent an attractive platform for vaccine development as a result of the ability to induce persistent humoral- and cellular-mediated immune responses against the encoded transgene. Compared with the parental integrating vector, the main advantages for using IDLV are the reduced hazard of insertional mutagenesis and the decreased risk for vector mobilization by wild-type viruses. Here we report on the development and use in the mouse immunogenicity model of simian immunodeficiency virus (SIV)-based IDLV containing a long deletion in the U3 region and with the 3' polypurine tract (PPT) removed from the transfer vector for improving safety and/or efficacy. Results show that a safer extended deletion of U3 sequences did not modify integrase-mediated or -independent integration efficiency. Interestingly, 3' PPT deletion impaired integrase-mediated integration but did not reduce illegitimate, integrase-independent integration efficiency, contrary to what was previously reported in the HIV system. Importantly, although the extended deletion in the U3 did not affect expression or immunogenicity from IDLV, deletion of 3' PPT considerably reduced both expression and immunogenicity of IDLV., Competing Interests: The authors declare no competing interests., (© 2021 The Author(s).)

Introduction Total knee arthroplasty (TKA) is one of the most common orthopedic procedures performed in the United States. Obtaining radiographs in the post-anesthesia care unit (PACU) has been the standard of care at most hospitals. The purpose of this study was to examine the utility and cost-effectiveness of immediate, postoperative radiographs in regards to operative decision-making to prevent complications within 90 days after primary TKA. Methods A retrospective review of 4,830 consecutive patients who underwent cemented or uncemented TKA between January 2016 and June 2019 at a large, regional medical center was performed. International Classification of Diseases, Tenth Revision (ICD-10) codes were used to track any readmissions within 90 days of TKA. If readmission was for a mechanical complication, including fracture, dislocation, or component loosening, PACU radiographs were reviewed for any abnormalities that may have prevented readmission. Results There were 195 readmissions (195 patients), of which 17 were due to mechanical complications. There was no evidence of fracture or abnormality appreciated on any of the reviewed PACU radiographs by either the reading radiologist or the senior authors. Assuming all fractures were noted on immediate, postoperative radiographs, the cost associated with identifying a single fracture in 2,415 patients was $1,072,260. Conclusion Routine radiographs in the recovery room after an uncomplicated primary TKA are not a reliable mechanism for preventing mechanical complications and do not alter patient care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Novack et al.)

The Orthopaedic In-Training Exam (OITE) is administered annually to orthopedic surgery residents to assess their medical knowledge. The authors provide a comprehensive review of the orthopedic oncology portion of the exam in order to aid residents in preparation for future in-training and licensing examinations as well as to help guide oncology residency education curriculum. All of the orthopedic oncology questions on the OITE from 2007 to 2019 were reviewed. Analysis included (1) the number of oncology questions each year, (2) question topic, (3) question taxonomy (knowledge versus interpretation), (4) the type of imaging modalities (radiological, histological), (5) most commonly cited references, and (6) level of evidence. Descriptive statistics were utilized to compare means between variables. From 2007 to 2019, there was a total of 292 tumor-related questions with a mean of 22.5 tumor-related questions (range 19-28) per year. Of the questions, 54.8% pertained to malignant tumors and 45.2% to benign tumors. Assessment of question taxonomy showed that 79.8% of questions required interpretation of imaging and analysis of the information provided versus 20.2% of questions being knowledge recall type. Of the questions, 76.7% required interpretation of radiological images, pathological images, or both. Orthopaedic Knowledge Update, Journal of the American Academy of Orthopaedic Surgeons, and Journal of Bone and Joint Surgery were the three most commonly cited question sources. Only 29 (9.84%) oncology questions over the past 13 years have been supported by level I or II sources of evidence. Better understanding of the OITE make-up, question distribution, and number and style of question, reference sources can improve an orthopedic residents' performance as well as better guide educational curriculum to prepare residents in their orthopedic oncology education.

Background Routine analysis of bone specimens in total joint arthroplasty (TJA) is mandatory at many institutions. The purpose of this study was to determine if mandatory routine TJA specimen analysis alters patient care or if they represent an unnecessary healthcare expenditure. Methods A retrospective review was performed of all primary TJA patients between October 2015 and December 2017 at our institution. Pathology results were reviewed to ascertain the number of concordant, discrepant, and discordant results. A diagnosis was considered concordant if the preoperative and pathologic diagnosis matched, discrepant if the preoperative and pathological diagnosis differed but no change in the patient's plan of care occurred, and discordant if the preoperative and pathologic diagnosis differed and resulted in a change in the patient's plan of care.  Results 3,670 total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures (3,613 patients) met the inclusion criteria and were included in this study. All 3,670 specimens had a concordant diagnosis; there were zero discrepant and zero discordant diagnoses. During the study period, our institution spent $67,246.88 in routine analysis of TJA specimens by a pathologist, with no change in any postoperative patient care plans. Conclusion With bundled payment reimbursement models and hospitals trying to decrease unnecessary expenditures, the present study helps further demonstrate that routine analysis has limited cost-effectiveness due to the low prevalence of alteration in the management of patient care. The decision for pathological analysis should be left at the discretion of the surgeon in order to maximize the cost-efficiency of TJA procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Koss et al.)

Children's development and health may be affected by toxic heavy metal exposure or suboptimal essential element intake. This study aimed to provide updated information regarding the concentrations of 41 elements in children's hair (aged under 18) living in a rural area of the Benishangul-Gumuz region, Ethiopia. The highest average levels (as a geometric mean) for toxic heavy metals were obtained for Al (1 mg kg -1 ), Pb (3.1 mg kg -1 ), and Ni (1.2 mg kg -1 ), while the lowest concentrations among the essential elements were found for Co (0.32 mg kg -1 ), Mo (0.07 mg kg -1 ), Se (0.19 mg kg -1 ), and V (0.8 mg kg -1 ). Hair analysis was combined with a survey to evaluate relationships and variations among subgroups and potential metal exposure predictors. Females showed significantly higher concentrations for most hair elements, excluding Zn, than males, and the 6-11 years age group reported the highest levels for Be, Ce, Co, Fe, La, Li, Mo, and Na. The main predictors of exposure to toxic elements were fish consumption for Hg and drinking water for Ba, Be, Cs, Li, Ni, Tl, and U. The data from this study can be used to develop prevention strategies for children's health and protection in developing countries.

Hip joint dislocation is the most common complication after a proximal femur replacement. As the utilization of proximal femur replacements continues to increase, it becomes imperative for surgeons to find the optimal method to decrease postoperative dislocation and its sequelae. These cases often involve extensive soft-tissue deficits that require reconstruction to provide postoperative strength and stability. Patients report good functional outcomes; however, dislocation remains a concern. Although "described" previously in the literature, the authors illustrate the "purse-string" hip joint capsular closure technique to help other surgeons understand it and apply to their practice as deemed necessary. We also present the senior author's results with using a modified version of the "purse-string" hip joint capsular closure technique., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

The humerus is a common site of metastatic tumor involvement and pathologic fracture. Intramedullary nailing is a treatment option that offers the benefit of protecting a long segment of diseased bone, but it is not without complications. This study aims to examine the survival, functional outcomes, and complications of patients treated with cement-augmented unlocked intramedullary nailing for actual and impending pathologic fractures of the humeral shaft., Methods: From 2014 to 2019, 26 patients were treated with this technique. Functional outcomes were assessed using the Musculoskeletal Tumor Society scoring system. Outcome scores, complications, reoperations, and mortality were determined by retrospective chart reviews and direct patient examinations., Results: The mean age at the time of surgery was 66.8 years. The mean follow-up was 20.2 months. Patients reported significant improvement in the mean Musculoskeletal Tumor Society score from 10.5 preoperatively to 26.1 after surgery ( P < 0.001). Five patients died of disease during the follow-up period. One patient had intraoperative fracture propagation during implant placement, and one patient experienced a postoperative rotator cuff tear., Discussion: Unlocked intramedullary nailing with cement augmentation is a reliable treatment method for actual and impending pathologic fractures of the humerus that results in favorable outcomes, including consistent pain relief and restoration of function., Competing Interests: None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Pizzo, Mr. Hoskins, Dr. Patel, Dr. Miller, Mr. Goyette, Mr. Mazzei, and Dr. Wittig., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Introduction: Limited English proficiency (LEP) patients face multiple care barriers and disproportionate risks for communication errors. Working with trained interpreters as a health care team can improve communication and drive high-quality care for LEP patients. Simulation and interprofessional education provide key strategies to address the critical training gap that exists at the intersection of patient safety, interprofessional practice, and cultural competence., Methods: Using action research principles across 16 months, we created a 3.5-hour simulation-based training for oral health and interpreting learners. The curriculum included profession-specific orientations with didactic and experiential content, three immersive simulations using start-stop-rewind methodology, virtual scenarios, and summary reflection discussions. A comprehensive tool kit facilitated curriculum implementation and standardization., Results: Forty-nine students from dentistry (first- through third-year predoctoral), dental hygiene, and dental therapy participated in this elective training during the 2017-2018 academic year; as required training, 126 third-year dental students participated in fall 2018. Students' familiarity with provider and interpreter best practices, appreciation of challenges faced by LEP patients, and confidence in skills working with spoken language interpreters increased. For all evaluation parameters, pre- and postsurvey ratings were statistically significant (chi-square tests, p < .001)., Discussion: The curriculum efficiently and effectively develops oral health and interpreting learners' abilities to work as a team with LEP patients. Curriculum design and resources address key barriers to feasibility and sustainability. The curriculum informs communication across all patient populations, revealing that getting by with partial understanding can be insufficient for any patient and any health care team., Competing Interests: None to report., (Copyright © 2020 Woll et al.)

Background: Postoperative infection is one of the most prevalent complications following total joint arthroplasty (TJA). As such procedures become more prevalent, it is imperative that we develop new prophylactic methods to prevent the need for revision procedures. In recent years, surgeons have opted to use antibiotic-loaded bone cement (ALBC) rather than plain bone cement (PBC) in primary hip and knee replacements due to its theoretical potential of lowering infection rates. However, the cost-effectiveness of this intervention remains in question.Questions/Purposes: To determine the rate of infection and cost-effectiveness of antibiotic-loaded bone cement as compared to plain bone cement in hip and knee arthroplasty., Patients and Methods: We reviewed 4116 primary hip and knee arthroplasty cases performed between 2016 and 2018 at Morristown Medical Center in New Jersey. Data regarding demographics, complications, and any readmissions due to deep infection were collected retrospectively. During that time period there were a total of 4016 knee cases (423 ALBC, 3593 PBC) and 123 hip cases (63 ALBC, 60 PBC). The average cost for one bag of antibiotic-loaded bone cement and plain bone cement for hip and knee arthroplasty was $336.42 and $72.14, respectively. A statistical analysis was performed using Fisher's exact test; the National Healthcare Safety Network (NHSN) surgical site infection guidelines were used to distinguish between superficial and deep infections., Results: Ten patients were readmitted due to deep infection, all of whom had undergone total knee arthroplasty. Of those cases, plain bone cement was used for the index procedure in seven instances and antibiotic-loaded cement was used in three. This resulted in an infection rate of 0.19% and 0.62%, respectively, p = 0.103. There was no statistically significant difference in infection rates between the two groups. A total of 778 bags of ALBC were used in 423 knee surgeries, and 98 bags of ALBC were used in 63 hip cases. The total cost for ALBC in TKA and THA procedures was $261,734.76 (778*336.42) and $32,969.16 (98*336.42), respectively. If PBC had been used during all index procedures, it would have resulted in a total savings of $231,509.28., Conclusions: Antibiotic-loaded cement did not significantly reduce the rate of infection for either knee or hip arthroplasty. Thus, the routine use of antibiotic-loaded cement in primary hip and knee arthroplasty may be an unnecessary financial burden to the healthcare system. A larger sample size and a randomized controlled trial would help confirm our findings and would provide further information on the cost-effectiveness of ALBC cement versus PBC.Significance/Clinical Relevance: In this review of cases performed from 2016 to 2018 there was no statistically significant difference between the rate of infection and the need for revision surgeries for patients treated with ALBC versus PBC. As hospital systems continue to transition towards a bundled payment model, it becomes imperative for providers to reduce any unnecessary costs in order to increase quality and efficiency. We estimate that our hospital system could save nearly $120,000/year by using plain bone cement instead of antibiotic-loaded cement., Competing Interests: “Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.”, (Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.)

Learners preferentially interpret novel nouns at the basic level ('dog') rather than at a more narrow level ('Labrador'). This 'basic-level bias' is mitigated by statistics: children and adults are more likely to interpret a novel noun at a more narrow label if they witness 'a suspicious coincidence' - the word applied to three exemplars of the same narrow category. Independent work has found that exemplar typicality influences learners' inferences and category learning. We bring these lines of work together to investigate whether the content (typicality) of a single exemplar affects the level of interpretation of words and whether an atypicality effect interacts with input statistics. Results demonstrate that both four- to five-year-olds and adults tend to assign a narrower interpretation to a word if it is exemplified by an atypical category member. This atypicality effect is roughly as strong as, and independent of, the suspicious coincidence effect, which is replicated.

In a multicultural society, the ability to work effectively with spoken-language interpreters is a critical skill for oral health professionals. The aims of this study were to design and evaluate training for oral health professions students to work effectively with interpreters as a health care team. A total of 89 University of Minnesota dental, dental hygiene, and dental therapy students and 41 Century College translating and interpreting students participated in the elective three-hour training from 2016 to 2018. The 89 oral health professions participants were invited to respond to a seven-item survey about working with interpreters and patients who are limited English proficient (LEP), along with a comparison group of an additional 462 oral health professions students who did not participate in the program. Of the oral health professions participants, 49 responded to the survey, for a 55% response rate; and 245 of the comparison group responded, for a 53% response rate. A qualitative focus group with 11 program participants and inductive analysis provided further insights. The differences between participants' pre and post self-ratings were statistically significant (p<0.001) for each of the seven survey questions. After training, students were more familiar with provider and interpreter best practices and the context for patients who are LEP, as well as more confident in their skills to work effectively with interpreters. Student focus groups identified training relevance and necessity and learning format as the most significant success factors. This project highlights the process and value of creating these experiences for and with students and the value of simulation to develop knowledge, skills, and confidence.

Purpose: The vast majority of the evidence on the prevalence of malignancy in endometrial polyps was obtained irrespectively of the time of diagnosis, i.e. including both women who were diagnosed at pre-surgical ultrasound and those who were diagnosed at the time of hysteroscopy. We hypothesize that this may represent an inaccuracy of potential clinical relevance since physicians have to take decisions regarding the need of surgery at the time of ultrasound diagnosis., Materials and Methods: Medical records of 2,245 patients who underwent hysteroscopy during a 4-year period were reviewed. Inclusion criterion was a pre-operative diagnosis of endometrial polyps., Results: 1,284 women (57 % of the cohort) were selected, of whom 36 were diagnosed with malignancies (2.8 %, 95 % CI 2.0-3.8). This prevalence markedly differ in pre- and post-menopause, being higher in the latter group (OR = 9.0, 95 % CI 2.6-30.3, p < 0.001). Six out of 803 resulted positive in the pre-menopausal group (0.7 %, 95 % CI 0.3-1.5) compared to 30 out of 481 in the post-menopausal group (6.2 %, 95 % CI 4.3-8.6). In the pre-menopausal group, a younger age resulted protective. The risk of malignancy in women younger than 50 years was 0.3 % (95 % CI 0.04-0.9). In the post-menopausal group, abnormal uterine bleeding (AUB) was associated with a diagnosis of malignancy (OR = 4.0, 95 % CI 1.9-8.5). The prevalence of malignancy in symptomatic and asymptomatic post-menopausal women was 11.8 % (95 % CI 7.6-17.1) and 3.0 % (95 % CI 1.4-5.3), respectively., Conclusions: The prevalence of malignancy among endometrial polyps detected at ultrasound is low and in line with the evidence obtained for a diagnosis made at the time of surgery. Some simple anamnestic information such as menopausal status, age and AUB helps identify women at higher risk and should be used in the decision-making process guiding the choice of surgery.

Introduction and Hypothesis: Platelet-rich fibrin (PRF) matrix is an autologous leukocyte and PRF biomaterial. PRF is a fibrin matrix polymerized in a tetramolecular structure with the incorporation of platelets, leukocytes, cytokines, and circulating stem cells. The three-dimensional structure of PRF is optimal for migration of endothelial cells and fibroblasts. It permits rapid angiogenesis and easier remodeling of fibrin in a more resistant connective matrix. In vaginal surgery, PRF may act as a graft material with better healing and better functional outcome., Methods: We performed a prospective observational study on ten consecutive women requiring surgery for prolapse recurrence (stage II or higher). These women had high risks for recurrence, erosion with graft materials, and intraoperative and postoperative complications with traditional pelvic reconstructive surgical procedures. ICS score and P-QoL Questionnaire results were assessed preoperatively and postoperatively. Surgery consisted of anterior, posterior, or apical repair plus PRF. Follow-up was performed at 1, 6, 12, 18, and 24 months., Results: Anatomically, the success rate was 80%. Prolapse symptoms improved by 100%. Sexual activity increased by 20% without dyspareunia. The surgical time was satisfactory (mean, 38.5 min). There were no intraoperative or postoperative complications., Conclusions: The use of PRF for site-specific prolapse repair is associated with a good functional outcome because of the healing and mechanical properties of PRF.

Background: Human natural killer (NK) cells are thought to play a role in antiviral response and tumor immune surveillance. The molecular mechanisms of down regulation of NK-cell activity observed after red blood cell (RBC) transfusion is still undefined., Study Design and Methods: Both effects of blood transfusion (ex vivo) and supernatants (SNs) derived from RBC units unstored (RBC-0) or stored for 5 or 30 days (RBC-5 or -30, respectively) in vitro were analyzed on NK cell-mediated cytolytic activity., Results: We have found that NK cells isolated from transfused patients on Day 3 lysed the NK-sensitive target cells K562 to a lesser extent than before transfusion. This down regulation of NK-cell activation was evident also for NK-cell killing mediated through the engagement of NK cell-activating receptors as NKG2D, NKp30, NKp46, and CD16. Transfused patients reacquired NK cell-mediated cytolytic activity from Day 5 to Day 7 after transfusion. SN from RBC-30, but not from RBC-0 or RBC-5, strongly inhibited the generation of lymphokine-activated killer (LAK) cells and lysis of the NK-resistant target cell Jurkat in a dose-dependent manner. Transforming growth factor-β1 (TGF-β1) blocking antibodies partially restored the generation of LAK activity. In addition, the depletion of both soluble Class I human leukocyte antigens (sHLA-I) and soluble Fas ligand (sFasL) from SN of RBC-30 completely restored the generation of LAK activity., Conclusions: Altogether, these findings would support the idea that blood transfusion-mediated down regulation of NK-cell activity is mediated by sHLA-I, sFasL, and TGF-β1., (© 2010 American Association of Blood Banks.)

Aim: The aim of the present study is to explore the sexual functioning of an Eating Disorders (ED) sample composed by Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS) patients., Methods: 98 patients (AN: 23; BN: 14; EDNOS: 61) have been compared with 88 health subjects. All participants have filled in the following questionnaires: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), Eating Disorders Examination (EDE-q), Binge Eating Scale (BES), Emotional Empathy Scale (EES). For the evaluation of the sexual activity Female Sexual Function Index (FSFI) was applied., Results: 67 patients (68.4%) and 80 healthy controls (90.9%) reported a sexual activity with a partner or masturbation in the four latest weeks. Only one healthy control (1.1%) reported masturbation and 79 (89.8%) controls showed sexual activity with a partner, on the contrary 11 patients (11.2) reported masturbation and 56 (57.1%) patients showed sexual activity with a partner. Moreover patients showed higher scores on every FSFI subscales. No significant differences were observed between AN, BN and BED in terms of FSFI scores., Discussion: Women with ED show a lower sexual activity with a partner, a six-fold increase in the risk of sexual dysfunction and an higher frequency of masturbation as the only sexual activity when compared with healthy controls. The cognitive distraction produced by the discomfort to show own body during a sexual intercourse with the partner may explain our results.

Introduction: Binge eating disorder (BED) is highly prevalent among individuals seeking treatment for obesity. No controlled studies assessing the sexual functioning of these patients have been published so far., Aim: To investigate the sexual functioning of a clinical sample of obese women affected by BED, comparing them with obese non-BED patients (Ob), and with normal weight controls., Methods: A consecutive series of 107 obese BED and 110 obese non-BED patients referring for the first time to the Clinic for Obesity of the University of Florence, together with a control group of 92 normal weight subjects, were studied., Main Outcome Measures: Patients were studied by means of the Structured Clinical Interview for DSM-IV and the Female Sexual Function Index (FSFI). Moreover, several self-reported questionnaires assessing the eating specific and general psychopathology were used., Results: BED and obese non-BED probands reported a lower sexual activity compared to controls, in terms of absence of sexual intercourse rate, and sexual intercourse frequency. BED patients showed lower FSFI total and subscales scores compared to Ob, and Ob probands reported lower scores compared to controls. According to the multiple linear regression analysis, emotional eating was the main determinant of FSFI scores (FSFI total score, desire, arousal, lubrication, orgasm, satisfaction) for both BED and Ob patients, while impulsivity (inversely associated with FSFI total, orgasm, and pain) and shape concern (inversely associated with arousal, lubrication, orgasm) were main determinants for BED patients only., Conclusions: BED patients, compared to obese non-BED and controls, have worse sexual functioning, which is associated with high levels of emotional eating, impulsivity, and shape concerns. The relationship between sexual functioning and eating psychopathology should be carefully addressed in obese patients with and without BED., (© 2010 International Society for Sexual Medicine.)

Background: Numerous mechanisms have been proposed to explain the beneficial action of intravenous immune globulin (IVIG) in autoimmune and systemic inflammatory disorders; among others, they could decrease pro-inflammatory cytokine levels and also induce anti-inflammatory cytokines., Materials and Methods: Ex vivo analysis of cells from ten IVIG recipients showed significant increase of IL-10 mRNA and intra-cellular IL-10 molecules in both leukotypes., Results: In vitro comparable results were obtained incubating CD8(+) T lymphocytes and neutrophils from healthy donors with IVIG. sHLA-I and/or sFasL immunodepletion abolished IL-10 modulation. Co-culture with contaminant-free IgM or MabThera did not exert any mRNA modulation. Finally, IgM or MabThera plus purified sHLA-I molecules enhanced IL-10-mRNA in both leukotypes to levels comparable to those obtained with IVIG incubation., Conclusion: As IVIG infusion involves administration of soluble contaminants, these data consent to speculate that IVIG might modulate IL-10 via the immunomodulatory activities of sHLA-I contaminant molecules inducing transcriptional and post-transcriptional modulation of IL-10 in CD8(+) T lymphocytes and neutrophils.

Loss of retinal ganglion cells occurs in a variety of pathological conditions, including central retinal artery occlusion, diabetes and glaucoma. Using an experimental model of retinal ischemia induced by transiently raise the intraocular pressure (IOP), In this study, we report the original observation that ischemic retinal ganglion cells death is associated with the transient deactivation of the pro-survival kinase Akt and activation of GSK-3beta followed, during reperfusion, by a longer lasting, PI3K-dependent, activation of Akt and phosphorylation of GSK-3beta. Under these experimental conditions, retinal ischemia induced the expression of Bad, a pro-apoptotic protein, member of the Bcl-2 family. The detrimental effects yielded by the ischemic stimulus were minimized by intravitreal administration of the NMDA receptor antagonist, MK801, that reduced the expression of Bad and significantly increased Akt phosphorylation. In conclusion, our present results contribute to unravel the mechanisms underlying retinal damage by high IOP-induced transient ischemia in rat. In addition, these data implicate the pro-survival PI3K/Akt pathway and the observed reduced expression of Bad in the neuroprotection afforded by MK801.

Background: Over the past decades, the weight of the published literature demonstrates that blood transfusions can induce clinically significant immunosuppression in recipients. Several studies showed significant improved clinical outcomes in the patients receiving leukoreduced transfusions, compared with control patients who received nonleukoreduced transfusions. Moreover, the immunosuppressive potential of blood products grows with the time of their storage and becomes highest in nonleukoreduced blood products stored for a long time., Study Design and Methods: The interest was previously focused on the determination of immunomodulatory soluble molecules such as soluble HLA Class I (sHLA-I) and soluble Fas ligand (sFasL) in different blood components and on the evaluation of their immunomodulatory activities. On this basis, whether soluble beta2-microglobulin free HLA Class I heavy chains (sHLA-beta2fHC) could be detected and immunochemically characterized in different blood components was evaluated. Immunomodulatory activity of detectable sHLA-beta2fHC molecules was evaluated by apoptosis inducing capacity in interleukin-2-activated antigen-specific cytotoxic T lymphocytes (CTL)., Results: Double-determinant immunoenzymatic assay indicates that sHLA-beta2fHC levels in red blood cells stored for up to 30 days and in random-donor platelets are significantly (p < 0.001) higher than in other blood components, and the immunochemical characterization suggests that the major source of sHLA-beta2fHC molecules might be the residual white cells that undergo membrane damage during storage. Finally, allogeneic CD8+ CTL apoptosis induction confirmed biofunctionality of sHLA-beta2fHC molecules., Conclusion: These data are comparable with those previously reported dealing with contaminant soluble molecules in allogeneic and autologous blood components, suggesting that sHLA-beta2fHC molecules could contribute to the immunosuppressive effects of blood transfusions.

Endogenous levels of the endocannabinoid anandamide, and the activities of the synthesizing and hydrolyzing enzymes, i.e. N-acylphosphatidylethanolamine-hydrolyzing phospholipase D and fatty acid amide hydrolase, respectively, were determined in the cortex and the striatum of rats subjected to transient middle cerebral artery occlusion. Anandamide content was markedly increased ( approximately 3-fold over controls; P < 0.01) in the ischemic striatum after 2 h of middle cerebral artery occlusion, but not in the cortex, and this elevation was paralleled by increased activity of N-acylphosphatidylethanolamine-hydrolyzing phospholipase D ( approximately 1.7-fold; P < 0.01), and reduced activity ( approximately 0.6-fold; P < 0.01) and expression ( approximately 0.7-fold; P < 0.05) of fatty acid amide hydrolase. These effects of middle cerebral artery occlusion were further potentiated by 1 h of reperfusion, whereas anandamide binding to type 1 cannabinoid and type 1 vanilloid receptors was not affected significantly by the ischemic insult. Additionally, the cannabinoid type 1 receptor antagonist SR141716, but not the receptor agonist R-(+)-WIN55,212-2, significantly reduced (33%; P < 0.05) cerebral infarct volume detected 22 h after the beginning of reperfusion. A neuroprotective intraperitoneal dose of 17beta-estradiol (0.20 mg x kg(-1)) that reduced infarct size by 43% also minimized the effect of brain ischemia on the endocannabinoid system, in an estrogen receptor-dependent manner. In conclusion, we show that the endocannabinoid system is implicated in the pathophysiology of transient middle cerebral artery occlusion-induced brain damage, and that neuroprotection afforded by estrogen is coincident with a re-establishment of anandamide levels in the ischemic striatum through a mechanism that needs to be investigated further.

Background: Red blood cell (RBC) transfusion has been linked to increased susceptibility to infections in critically ill patients and to augmented incidence of postoperative infections. The mechanisms by which transfusions can induce immunosuppression are only partially defined. Recently, it has been demonstrated that RBC supernatants inhibit neutrophil migration. Such inhibitory activity is due to transforming growth factor (TGF)-beta1 contained in the supernatants that desensitize neutrophils to subsequent chemotaxic stimulation., Study Design and Methods: In ancillary experiments, it was observed that plasma from transfused patients maintained its capacity of inhibiting neutrophil chemotaxis several days after RBC transfusion. Thus, this study was planned to investigate the mechanism(s) responsible for the prolonged inhibition of neutrophil chemotaxis observed after RBC transfusion., Results: Plasma samples obtained from subjects who underwent RBC transfusion display a capability of inhibiting neutrophil chemotaxis, which is detectable up to 15 days after the transfusion. The inhibition is related to the capacity of FasL and HLA-I molecules contained in RBC supernatants to induce in vivo TGF-beta1 synthesis by neutrophils. The induction of TGF-beta1 secretion in neutrophils by HLA-I molecules depends on immunoglobulinlike transcript 1/CD85 triggering., Conclusion: The property of RBC transfusion of inducing a sustained inhibition of neutrophil chemotaxis seems to be a potential mechanism that concurs to the susceptibility to infections in patients who receive transfusions. Furthermore, our findings, showing neutrophil production of TGF-beta1 in response to FasL and HLA-I molecules, confirm that neutrophils are endowed not only with effector functions but also with immunomodulatory properties possibly involved in the regulation of inflammatory processes.

In this contribution, a revision of ionizing radiations exposed workers' dosimetric data in four hospital structures is showed, and, consequently, recommended optimization measures are identified.

Italian law 125/2001 implementation requires to Occupational Health Physicians to carry out alcohol levels checks in the workplaces. Firstly, this contribution proposes to specify the methodological differences between breathing alcohol concentration, BrAC, and blood alcohol concentration, BAC, and also to show the different sampling strategies. Therefore, a standardised practice proposal for alcohol levels determinations in workers communities is presented, in the contest of a modern Occupational Health services "integrated quality system".

A radiochromatographic method has been set up to assay the activity of N-acyl-phosphatidylethanolamine-specific phospholipase D (NAPE-PLD), based on reversed-phase high-performance liquid chromatography (HPLC) and online scintillation counting. The anandamide (N-arachidonoylethanolamine, AEA), product released by NAPE-PLD from the N-arachidonoyl-phosphatidylethanolamine (NArPE) substrate, was separated using a C18 column eluted with methanol-water-acetic acid and was quantified with an external standard method. Baseline separation of AEA and NArPE was completed in less than 15 min, with a detection limit of 0.5 fmol AEA at a signal-to-noise ratio of 4:1. The sensitivity and accuracy of the radiochromatographic procedure allowed detection and characterization of NAPE-PLD activity in very tiny tissue samples or in samples where the enzymatic activity is very low. With this method, we could determine the kinetic constants (i.e., apparent Michaelis-Menten constant (Km) of 40.0+/-5.6 microM and maximum velocity (Vmax) of 22.2+/-3.5 pmol/min per milligram protein toward NArPE) and the distribution of NAPE-PLD activity in brain areas and peripheral tissues of mouse. In addition, we could collect unprecedented evidence that compounds widely used in studies of the endocannabinoid system (e.g., AEA and congeners, receptor a(nta)gonists and inhibitors of AEA degradation) can also affect NAPE-PLD activity.

Studies comparing transfusion and nontransfusion patients suggest an increased risk of postoperative infections in transfusion groups. Supernatants of blood components have been shown to affect the function of T lymphocytes and natural killer cells. Here, we found that supernatants from stored red blood cells (RBCs) inhibit human neutrophil migration in response to formyl peptides and stimulate neutrophil locomotion. These effects can be observed with high dilutions of RBC supernatants, such as 1:5 x 106 (vol/vol), able to trigger locomotion as well as desensitization of the cells to alternative chemoattractants. The phenomenon might be mediated by chemoattractants present in the supernatants. As RBC supernatants failed to mobilize intracellular free calcium, the chemoattractants should belong to the group of pure chemoattractants, that is, soluble Fas ligand (sFasL) and transforming growth factor-beta1 (TGF-beta1), known to act without increasing calcium levels. Recombinant TGF-beta1, but not sFasL, was found to reproduce the ability of RBC supernatants to both inhibit neutrophil response to formyl peptides and stimulate neutrophil locomotion. Moreover, TGF-beta1-immunodepleted supernatants did not display neutrophil-directed activities. Finally, RBC supernatants from RBCs stored after depletion of leukocytes were incapable of affecting neutrophil function. With neutrophils acting as a first-line antimicrobial defense, the ability, shown here, of high dilutions of RBC supernatants to inhibit neutrophil chemotaxis through TGF-beta1 may be a relevant determinant of infections in the postoperative period for transfusion patients. Consistently, the neutrophil chemotactic response to formyl peptide was inhibited by the plasma obtained from 5 transfusion patients.

Background: The immunomodulatory effects of allogeneic blood transfusion may contribute to a poor prognosis in patients with cancer who are undergoing surgery, and clinical trials have been carried out to investigate whether these patients would benefit from autologous blood donation. As the immunomodulatory effects of allogeneic blood transfusion have been related to soluble molecules released from residual WBCs during storage, the in vitro immunomodulatory activity of soluble molecules detected in supernatants from stored autologous blood was evaluated., Study Design and Methods: Blood was donated by four healthy volunteers. Packed WBC-reduced RBCs were obtained and stored for 30 days, and supernatants were collected. FFP and serum were also obtained. The concentration of soluble molecules was determined by immunoenzymatic assays. The in vitro immunomodulatory activity of undiluted blood component supernatant was assessed by antigen-specific cytotoxic T-cell activity and mixed lymphocyte reactions in autologous combinations and by apoptosis induction in Fas+ cells., Results: The concentrations of soluble Fas-ligand and HLA class I molecules were higher in packed RBCs than in WBC-reduced RBCs, FFP, and serum. Undiluted supernatants of packed RBCs strongly inhibited functional assays and induced apoptosis in Fas+ cells. The immunomodulatory effects were correlated with the amount of soluble Fas ligand and HLA class I molecules., Conclusion: The results of the present study are comparable with those already reported in allogeneic blood components, and they indicate that undiluted supernatants of autologous blood components may exert immunosuppressive effects in vitro.

It has been known for many years that blood transfusions may have immunomodulatory effects, however an ultimate explanation of this phenomenon is lacking. In the present paper we report that the concentrations of soluble HLA class I (sHLA-I) and soluble Fas ligand (sFasL) molecules in supernatants of blood components which contain elevated numbers of residual donor leukocytes, like red blood cells and random-donor platelets, are significantly higher than in other blood components. Elevated amounts of sFasL molecules are also found in some commercial immunoglobulin preparations. sHLA-I and sFasL molecules in blood components and in immunoglobulin preparations are biologically active in vitro as they inhibit mixed lymphocyte responses and cytotoxic T cell activity in allogeneic and autologous combinations and induce apoptosis in Fas-positive cells. If these results are paralleled in vivo the amount of sHLA-I and sFasL molecules should be taken into account in clinical practice in order to select the blood component and the immunoglobulin preparation which could induce the desired immunomodulatory effect in the recipient.

Cardiac chambers have afferent connections to the brainstem and to the spinal cord. Vagal afferents mediate depressor responses and become activated by volume expansion, increased myocardial contractility and atrial natriuretic factor. Sympathetic afferents, on the contrary, are activated by metabolic mediators, myocardial ischemia and cardiac enlargement. These opposite behaviors may lead to activation or suppression of the sympathetic nervous system and of the renin-angiotensin-aldosterone system. As cardiac diseases progress, the heart dilates, plasma norepinephrine increases, atrial natriuretic factor is released and the renin-angiotensin-aldosterone system is suppressed to maintain water and sodium excretion. This dissociation of the neurohormonal profile of cardiac patients, may be explained by coactivation of sympathetic afferents, by cardiac dilatation, and of vagal afferents by atrial natriuretic factor. In more advanced stages, atrial natriuretic factor suppression of the renin-angiotensin-aldosterone system is overridden by overt sympathetic activation and sodium and water retention ensues. Digitalis, angiotensin-converting enzyme inhibitors and beta-blockers selectively decrease cardiac adrenergic drive. A common mechanism of action, to all three groups of drugs, would be attenuation of sympathetic afferents and partial normalization of vagal afferents. Consequently, heart size and cardiac afferents emerge as the key factors to understand the pathophysiology and treatment of the syndrome of congestive heart failure., (Copyright 2000 Harcourt Publishers Ltd.)

The immunomodulatory effect of allogeneic blood transfusions (ABT) has been known for many years. However, a complete understanding of the effects of ABT on the recipient's immune system has remained elusive. Soluble HLA class I (sHLA-I), HLA class II (sHLA-II), and Fas ligand (sFasL) molecules may play immunoregulatory roles. We determined by double-determinant immunoenzymatic assay (DDIA) sHLA-I, sHLA-II, and sFasL concentrations in different blood components. sHLA-I and sFasL levels in red blood cells (RBCs) stored for up to 30 days and in random-donor platelets are significantly (P <.001) higher than in other blood components and their amount is proportionate to the number of residual donor leukocytes and to the length of storage. Blood components with high sHLA-I and sFasL levels play immunoregulatory roles in vitro as in allogeneic mixed lymphocyte responses (MLR) and antigen-specific cytotoxic T-cell (CTL) activity, and induce apoptosis in Fas-positive cells. These data suggest that soluble molecules in blood components are functional. If these results are paralleled in vivo, they should be taken into account in transfusion practice. Blood components that can cause immunosuppression should be chosen to induce transplantation tolerance, whereas blood components that lack immunosuppressive effects should be preferred to reduce the risk of postoperative complications and cancer recurrence.

Plasma exchange (PE) is considered first-line treatment for thrombotic thrombocytopenic purpura (TTP) to the point that many clinicians regard it as definitive therapy. Studies have reported response rates to PE ranging from 39% to 78%. In our experience, a minority of patients have been cured solely by PE. While adjuvant therapies (e.g., vincristine, splenectomy) have proved effective in anecdotal reports, protocols using these therapies in the treatment of TTP have not been established. Management of TTP over a 15-year period was reviewed to evaluate (1) the rate of cure accomplished by PE alone, and (2) the potential benefit of additional therapies. The records of 29 consecutive patients with TTP treated by PE were reviewed and classified according to response to PE alone and the need for adjuvant therapy. Eight patients (28%) achieved remission and long-term survival with PE alone. With the addition of adjuvant therapy another 13 patients survived, bringing the total survival to 72%. Fifteen patients were treated with vincristine in addition to PE. Only three of seven patients receiving vincristine after failing to respond completely to PE survived, but survival increased to 88% (7 of 8) when vincristine was administered within 3 days of beginning PE. These data suggest that PE alone may not be sufficient therapy for most patients with TTP. Additional therapy is often needed to achieve long-term survival. While controlled trials will be necessary to prove the efficacy of vincristine, we believe that, given the minimal risk of vincristine toxicity and the grave consequences of ineffective therapy, routine administration of vincristine early in the course of PE should be considered.

We studied the occurrence of seizure disorders within the immediate family in 3 groups of probands: (1) 64 epileptic children with nonconvulsive status epilepticus (NCSE); (2) 454 epileptic children who have had no episodes of NCSE; (3) 306 healthy children, matched for age and sex. Recurrence of seizures among relatives of epileptic probands without NCSE was significantly higher than among the general population, both in generalized and partial epilepsies. We also observed an increased incidence of convulsions among the relatives of probands with NCSE and the general population; no differences were noted between epileptic children with or without NCSE. These data support the hypothesis that genetic factors play an important role in the etiology of seizure disorders in children with NCSE.