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Realizamos um sobrevoo abrangente sobre a teoria estatística da turbulência, com a preocupação de embasá-la em noções importantes e consolidadas da dinâmica de fluidos, antes de nos aprofundarmos em discussões de modelos mais específicos, sujeitos a debates contemporâneos. A complexidade da turbulência traduz-se, na chamada abordagem estrutural, como o desafio de compreender, a partir da dinâmica de tubos de vorticidade, o transporte de energia das grandes para as pequenas escalas do escoamento, no limite singular de viscosidade nula. Propriedades estatísticas da cascata de energia, como o fenômeno da intermitência, são modeladas por meio de narrativas aparentemente diversas, associadas a processos estocásticos multiplicativos e, alternativamente, à formulação multifractal do espectro de singularidades do campo de velocidade turbulento. A síntese, fundamentação de primeiros princípios e integração dessas duas visões de modelagem à abordagem estrutural forma o corpo essencial das dificuldades teóricas atuais da turbulência.

The extent of springtime Arctic ozone loss does not reach Antarctic ``ozone hole'' dimensions because of the generally higher temperatures in the northern hemisphere vortex and consequent less polar stratospheric cloud (PSC) particle surface for heterogeneous chlorine activation. Yet, with increasing greenhouse gases stratospheric temperatures are expected to further decrease. To infer if present Antarctic PSC occurrence can be applied to predict future Arctic PSC occurrence, lidar observations from McMurdo station (78° S, 167° E) and NyÅlesund (79° N, 12° E) have been analysed for the 9 winters between 1995 (1995/1996) and 2003 (2003/2004). Although the statistics may not completely cover the overall hemispheric PSC occurrence, the observations are considered to represent the main synoptic cloud features as both stations are mostly situated in the centre or at the inner edge of the vortex. Since the focus is set on the occurrence frequency of solid and liquid particles, the analysis has been restricted to volcanic aerosol free conditions. In McMurdo, by far the largest part of PSC observations is associated with NAT PSCs. The observed persistent background of NAT particles and their potential ability to cause denoxification and irreversible denitrification is presumably more important to Antarctic ozone chemistry than the scarcely observed ice PSCs. Meanwhile in Ny-Ålesund, ice PSCs have never been observed, while solid NAT and liquid STS clouds both occur in large fraction. Although they are also found solely, the majority of observations reveals solid and liquid particle layers in the same profile. For the Ny-Ålesund measurements, the frequent occurrence of liquid PSC particles yields major significance in terms of ozone chemistry, as their chlorine activation rates are more efficient. The relationship between temperature, PSC formation, and denitrification is nonlinear and the McMurdo and Ny-Ålesund PSC observations imply that for predicted stratospheric cooling it is not possible to directly apply current Antarctic PSC occurrence to the Arctic stratosphere. Future Arctic PSC occurrence, and thus ozone loss, is likely to depend on the shape and barotropy of the vortex rather than on minimum temperature alone.

CLINICAL CASE A 43-year-old Romanian woman was referred with the clinical suspicion of gastric lymphoma; she had complained from two months nausea, vomiting and weight loss (7 kg); 3 esophagogastroduodenoscopic examinations had evidenced reduced distensibility of stomach body and antrum, ulcered and congestive mucosa, the histopathological examinations revealed a non specific inflammation. There was no response to therapy with omeprazolo. A computer-assisted tomoghraphy scan of the thorax and abdomen, obtained after the oral and intravenous administration of contrast material, showed diffuse thickening of the gastric wall, lymphadenopathies were seen in the retrocrural space, lesser curvature, and paraaortic region. It was performed another upper endoscopy with “deep” biopsy specimen, comprehensive of spirochetal immunohistochemistry, that was diagnostic for gastric syphilis. DISCUSSION Even though gastritis is a rare clinical manifestations of the secondary stage of syphilis, it must be considered in the differential diagnosis of erosive gastritis unresponsive to medical therapy, especially in young patients; screening tests like VDRL (routinely used until few years ago in internal medicine divisions) may be useful to identify those patients needing a further diagnostic evaluation.

Food-to-food fortification and fermentation are effective strategies to enhance the product functionality and nutrient density of infant complementary foods. However, their effectiveness hinges on a deep understanding of ingredient combinations. Our research focused on the physicochemical and techno-functional aspects of sorghum-baobab blends, comparing two processes: 'co-ferment-cook' and 'ferment-cook-fortify'. The results show that both techniques improved the water absorption capacity by 17-20% and the water solubility index increased by over 100% while maintaining a comparable nutritional composition and energy density. The calculated energy density (2048.8-2345 kJ day -1 ) was sufficient for both blends for infants 6-11 months old with an average breast milk intake. Viscosity, another crucial factor for complementary feeding, improved significantly ( P < 0.05) after co-ferment-cook compared to ferment-cook-fortify reaching a value suitable for children older than 18 months. Starch digestibility increased with co-ferment-cook, while protein digestion increased with fortified non-fermented foods. In conclusion, our findings emphasize that combining fermentation and fortification processing steps is optimal for balancing the nutritional and techno-functional properties of sorghum porridges for infant complementary foods. Processing parameters must be optimized to reach the viscosity suitable for complementary feeding at the assigned soluble solid contents for the age group 6-24 months.

We carry out an in-depth analysis of a recently introduced vortex gas model of homogeneous and isotropic turbulence. Direct numerical simulations are used to provide a concrete physical interpretation of one of the model's constituent fields: the degree of vortex polarization. Our investigations shed light on the complexity underlying vortex interactions and reveal, furthermore, that despite some striking similarities, classical and quantum turbulence exhibit distinct structural characteristics, even at inertial range scales. Crucially, these differences arise due to correlations between the polarization and circulation intensity within vortex clusters.

Blended complementary foods from cereals and high-protein sources are used worldwide to cope with infants' malnutrition. However, the usefulness of the food matrix during traditional processes reaches suboptimal effectiveness due to cereal gelatinization and viscosity, which reduce consumption. The interplay between nutritional and physical qualities needed for weaning children presents further significant constraints. A combination of processing methods can improve and optimize the overall product quality. This paper investigated the nutritional, functional, and anti-nutritional factors of a complementary infant porridge made by combining fermented sorghum flour with germinated bottle gourd seed flour. Overall, the combination improved the functional and physical properties of the porridge suitable for children of 10 months and over. A serving of 100 g would contribute 115-145% and 23-31% of the recommended nutritional intake of protein and energy, respectively, for low breast milk energy between 6-24 months. The results demonstrate that a combination of strategies and technologies are needed to balance nutritional and physical quality.

Objective: To analyze the clinical management, the outcomes, and the trend in hysterectomy rates (HR) in patients who underwent this procedure for cervical intraepithelial neoplasia (CIN)., Methods: Multicentric retrospective observational study conducted on 242 patients who underwent hysterectomy for CIN between 2010 and 2020 in nine Italian institutions. Hysterectomy for invasive or micro-invasive neoplasia, sub-total hysterectomy, or trachelectomy were excluded., Results: A significant increase in the trend of HR for CIN was recorded (P = 0.002, r = 0.81; C.I. 95%: 0.415-0.949); HR increased from 0.46% in the year 2010 to 3.32% in 2020. The mortality rate was 0.4%, and 5% had operative complications. On definitive histopathology examination, a CIN of any grade was recorded in 71.5% of cases, and an occult invasive cancer in 1.24%. No pathology or CIN1 was found in 26.8% of cases, suggesting over treatment. During follow-up, a vaginal lesion was recorded in 5% of cases., Conclusion: A significant increase in the number of hysterectomies performed for CIN in the last 10 years was recorded. Hysterectomy for CIN can lead to complications, risk of the onset of vaginal lesions, and risk of overtreatment, and remains, in the first instance, an unacceptable treatment, to be proposed only after adequate counseling., (© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Recent numerical explorations of extremely intense circulation fluctuations at high Reynolds number flows have brought to light novel aspects of turbulent intermittency. Vortex gas modeling ideas, which are related to a picture of turbulence as a dilute system of vortex tube structures, have been introduced alongside such developments, leading to accurate descriptions of the core and the intermediate tails of circulation probability distribution functions (cPDFs), as well as the scaling exponents associated to statistical moments of circulation. We extend the predictive reach of the vortex gas picture of turbulence by emphasizing that multifractality breaking, one of its salient phenomenological ingredients, is the key concept to disclose the asymptotic form of cPDF tails. A remarkable analytical agreement is found with previous results derived within the framework of the instanton approach to circulation intermittency, a functional formalism devised to single out the statistically dominant velocity configurations associated to extreme circulation events.

The small-scale statistical properties of velocity circulation in classical homogeneous and isotropic turbulent flows are assessed through a modeling framework that brings together the multiplicative cascade and the structural descriptions of turbulence. We find that vortex structures exhibit short-distance repulsive correlations, which is evidenced when they are "tomographically" investigated, by means of planar cuts of the flow, as two-dimensional vortex gases. This phenomenon is suggested from model improvements which allow us to obtain an accurate multiscale description of the intermittent fluctuations of circulation. Its crucial new ingredient, the conjectured hard disk behavior of the effective planar vortices, is then found to be strongly supported from a study of their spatial distributions in direct numerical simulations of the Navier-Stokes equations.

Competing Interests: The author declares no competing interest.

Multifractal systems usually have singularity spectra defined on bounded sets of Hölder exponents. As a consequence, their associated multifractal scaling exponents are expected to depend linearly on statistical moment orders at high-enough orders-a phenomenon referred to as the linearization effect. Motivated by general ideas taken from models of turbulent intermittency and focusing on the case of two-dimensional systems, we investigate the issue within the framework of Gaussian multiplicative chaos. As verified by means of Monte Carlo simulations, it turns out that the linearization effect can be accounted for by Liouville-like random measures defined in terms of upper-bounded scalar fields. The coarse-grained statistical properties of Gaussian multiplicative chaos are furthermore found to be preserved in the linear regime of the scaling exponents. As a related application, we look at the problem of turbulent circulation statistics, and obtain a remarkably accurate evaluation of circulation statistical moments, recently determined with the help of massive numerical simulations.

Statistical properties of circulation encode relevant information about the multiscale structure of turbulent cascades. Recent massive computational efforts have posed challenging theoretical issues, such as the dependence of circulation moments upon Reynolds numbers and length scales, and the specific shape of the heavy-tailed circulation probability distribution functions. We address these focal points in an investigation of circulation statistics for planar cuts of three-dimensional flows. The model introduced here borrows ideas from the structural approach to turbulence, whereby turbulent flows are depicted as dilute vortex gases, combined with the standard Obukhov-Kolmogorov phenomenological framework of small-scale intermittency. We are able to reproduce, in this way, key statistical features of circulation, in close agreement with empirical observations compiled from direct numerical simulations.

Relaminarization of wall-bounded turbulent flows by means of external static magnetic fields is a long-known phenomenon in the physics of electrically conducting fluids at low magnetic Reynolds numbers. Despite the large literature on the subject, it is not yet completely clear what combination of the Hartmann (M) and the Reynolds number has to be used to predict the laminar-turbulent transition in channel or pipe flows fed by upstream turbulent flows free of magnetic perturbations. Relying upon standard phenomenological approaches related to mixing length and structural concepts, we put forward that M/R&#95;{τ}, where R&#95;{τ} is the friction Reynolds number, is the appropriate controlling parameter for relaminarization, a proposal which finds good support from available experimental data.

The interpretation of data obtained from particle image and tracking velocimetry in the study of superfluid flows has been so far a challenging task. Tracking particles (as solid hydrogen or deuterium) are attracted to the cores of quantized vortices, so that their dynamics can be strongly affected by the surrounding vortex tangle. Previous phenomenological arguments indicate that tracking particles and microsized vortex rings could form bound states (denoted here as VRP states). While a comprehensive description of the vortex ring-particle bonding mechanism has to deal with somewhat involved flow configurations, we introduce a simplified two-dimensional model of VRP states, which captures essential qualitative features of their three-dimensional counterparts. Besides an account of known experimental and numerical observations, the model proves to be of great heuristic interest. In particular, it sheds light on the important role played by viscous dissipation (due to the normal component of the fluid), the Magnus force, and topologically excited vortex rings in the stability and dynamics of VRP states.

We study the onset of intermittency in stochastic Burgers hydrodynamics, as characterized by the statistical behavior of negative velocity gradient fluctuations. The analysis is based on the response functional formalism, where specific velocity configurations-the viscous instantons-are assumed to play a dominant role in modeling the left tails of velocity gradient probability distribution functions. We find, as expected on general grounds, that the field-theoretical approach becomes meaningful in practice only if the effects of fluctuations around instantons are taken into account. Working with a systematic cumulant expansion, it turns out that the integration of fluctuations yields, in leading perturbative order, to an effective description of the Burgers stochastic dynamics given by the renormalization of its associated heat kernel propagator and the external force-force correlation function.

Objectives: To evaluate cervical regeneration at 6 months following excisional treatment for high-grade cervical intraepithelial neoplasia (CIN), and to investigate the effect of cone dimensions, age of patients and technique of excision on the efficacy of the regeneration process., Design: Prospective observational multicentric study., Setting: Three tertiary care and research centres., Participants: Among the 197 eligible women of childbearing age, older than 25 years of age, undergoing for the first time a loop electrosurgical excision procedure or carbon dioxide laser cervical excision for a high-grade CIN at the colposcopy-directed cervical punch biopsy, and with a final diagnosis of high-grade CIN, 165 completed the 6-month follow-up and were included in the analysis., Primary Outcome Measures: The cervical length and volume regeneration (%) after 6 months from procedure were determined by three-dimensional ultrasound, and the correlation of regeneration with cone dimensions, age and excision technique was evaluated., Results: The mean±SD cervical length regeneration at 6 months was 89.5%±6.3% and the mean±SD cervical volume regeneration was 86.3%±13.2%. At the multivariate analysis, a significant and independent inverse correlation between excised cone length and cervical regeneration emerged (r=-0.39, P<0.001). A significantly negative trend in length regeneration at 6 months from procedure with an increasing class of cone length was found (P<0.001). No significant association was found in relation with patient age at the time of procedure or with the technique of excision., Conclusions: Cervical length regeneration at 6 months from excisional treatments is negatively affected by an increasing cone length but not from the age of the patient or the technique of excision. While still achieving equal clinical efficacy, it is crucial to contain cone dimensions, in order to favour a greater length regeneration, reducing the cervical harm and the potential future obstetric complications., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The aim of this study was to evaluate the influence of body mass index (BMI) and ultrasound-estimated visceral adipose tissue deposits on oocyte quality and pregnancy rate in women undergoing Assisted Reproductive Technology (ART) procedures. The study included 58 women who underwent ART procedures. According to their BMI, the women were divided into normal weight and overweight/obese; an ultrasound evaluation of preperitoneal fat thickness (PFT) was also performed for each patient. The oocyte quality was then assessed, and samples of follicular fluid were collected from each woman, in order to evaluate the intrafollicular concentration of reactive oxygen species (ROS) as markers of oxidative stress and pro-inflammatory cytokines (IL-1β and IL-6) as markers of chronic inflammation. A negative correlation was found between BMI (as well as PFT) and the number of retrieved oocytes (r = -0.3; p <0.05 and r = -0.5; p < 0.001, respectively), good quality oocytes (r = -0.4; p = <0.05) and obtained embryos (r = -0.3; p < 0.05). In women undergoing ART procedures, BMI and PFT negatively influence the number of oocytes retrieved and their quality. However, on multivariable analysis, only age, PFT and number of retrieved oocytes affect the success rate of ART procedures.

Objective: The aim of the present investigation was to evaluate the cervical conizations performed in the last 20 years in a single institution, with a particular interest in analyzing the trend of the length of cone excisions., Patients and Methods: A retrospective cohort study of women who underwent a CO2-laser cervical conization between January 1996 and December 2015. Cytological abnormalities on referral pap smear, colposcopic findings and pertinent clinical and socio-demographic characteristics of each woman were collected. In particular, the length of cone specimen was evaluated, taking into account all the factors potentially influencing the length of excision., Results: A total of 1270 women who underwent cervical conization from January 1996 to December 2015 were included in the analysis. A mean cone length of 15.1 ± 5.7 mm was reported, and we observed a significant decrease in the length of cone excisions over the whole study period. Age (rpartial = 0.1543, p < 0.0001), see & treat procedure (rpartial = -0.1945, p < 0.0001) and grade II colposcopic findings (rpartial = 0.1540, p < 0.0001) were significantly associated with the length of cone excision on multivariate analysis., Conclusions: In the last 20 years, a significant decrease in the length of cone excision was observed. In our opinion, this can be due to the acquired awareness by the gynecologists of the potential disadvantages of wide cone excision in term of adverse obstetric outcomes in future pregnancies.

Objective: We undertook a retrospective analysis of the incidence of complications of carbon dioxide (CO2) laser excision for high-grade vaginal intraepithelial neoplasia (HG-VaIN)., Materials and Methods: Retrospective large case series on 128 CO2 laser excisions for HG-VaIN in 106 women treated at the Department of Gynecologic Oncology, Oncologic Referral Center, Aviano, Italy. These procedures were performed under local anesthesia with a 20-W continuous laser beam focused to a 0.2-mm spot size. Complications were defined as "minor" when limited to vagina, and "major" when surrounding organs were injured or the vaginal vault was opened.To identify possible factors associated with surgical complications, we performed a univariate analysis with the t test for continuous variables and χ or Fisher exact test for qualitative variables as appropriate., Results: The overall rate of complication was 7.8% (10/128); nine of them were vaginal bleeding, and only one (0.8%) was a major complication with vaginal vault perforation.A greater number of previous destructive treatments and of two or more previous laser vaginal excisional treatments was present in patients with complications compared with ones without complications (10% vs 3.9 %, p = .92, and 30% vs 15.2%, p = .44, respectively), although these differences were not statistically significant. A total of 10.5% (6/57) of occult vaginal cancer was detected in women with initial diagnosis of VaIN3 (HG-VaIN) on biopsy., Conclusions: Carbon dioxide laser excision for HG-VaIN seems to be a safe approach with low rate of complications, probably because of the better accuracy achieved by CO2 laser resections, and permits diagnosis of occult invasive disease.

Uterine fibroids are the most common neoplasm of the genital tract in reproductive women. Obesity holds a role as risk factor for uterine fibroids, through hormonal and inflammatory mechanisms. Visceral fat is a hormonally active tissue, so an increase in visceral fat may be considered as a risk factor, through the increased production of inflammatory mediators. The aim of the study was, therefore, to evaluate the association between the presence of uterine fibroids and fat tissue distribution, and to assess the efficacy of both anthropometric and instrumental indicators, in particular the sonographic measurement of preperitoneal fat thickness (PFT) and subcutaneous fat thickness (SFT). Study group consisted of childbearing-age women with at least one uterine fibroid with a diameter ≥10 mm (n = 71), all the childbearing-age women who access to the outpatient service of our institution in the same period, without evidence of uterine fibroids, constituted the control group (n = 145). A significantly difference in BMI (p = 0.0034), PFT (p < 0.0001), and SFT (p = 0.0003) emerged. At the multivariate analysis, only PFT showed an independent significant association with the presence of uterine fibroids (p < 0.0001). The ROC curve analysis identified a cut-off value of 6.7 mm of PFT as discriminator for the presence of uterine fibroids.

To date, there are evidence-based guidelines available for cervical dysplasia diagnosed in pregnancy. Certain functional biomarkers have proven useful in the prediction of regressing and non-regressing cervical intraepithelial neoplasia (CIN) lesions in non-pregnant women. In the present study, Ki-67 and p16 immunostaining were evaluated in different grades of CIN lesions diagnosed in pregnant or non-pregnant women with the aim to identify any differences in order to better understand the behavior of CIN in pregnancy. The current retrospective case-control study included 17 pregnant patients that conceived naturally with first-time onset of CIN occurring at no later than 16 gestational weeks. The control group included 17 non-pregnant patients matched for age, parity and number of previous sexual partners. Exclusion criteria included previous cervical treatment, immunocompromised status, chronic hepatitis B and/or C and cigarette smoking. p16 and Ki-67 protein expression were respectively detected using the CINtec Histology kit and monoclonal antibodies against Ki-67. p16 and Ki-67 staining were analyzed using a classification system based on the distribution of positivity on a semi-quantitative three point-scale. p16 and Ki-67 immune reactivity correlated positively with the grade of epithelial dysplasia in the total cohort of pregnant and non-pregnant patients; expression increased linearly from CIN1 to CIN3. Furthermore, the association between p16 immunostaining and CIN grade was significant in non-pregnant patients but not in pregnant patients. In pregnant patients, positivity for Ki-67 was less intense than in non-pregnant patients. These results appear to suggest that pregnancy status interferes with the expression of cellular proteins involved in cell-cycle regulation and the carcinogenic process induced by high-risk human papilloma virus, exhibiting increased variability in their staining.

Objective: To analyze the growth trend of small uterine fibroids during early pregnancy, evaluating the potential factors involved, with particular interest in hCG levels., Design: Observational study., Setting: Tertiary care university hospital., Patient(s): Women who had an ultrasound diagnosis of small myomas (diameter, ≥10 mm and ≤50 mm) from January 2007 to December 2013, and who subsequently became pregnant within 1 year., Intervention(s): None., Main Outcome Measure(s): Three additional ultrasound examinations were performed during early pregnancy (7-8, 10-13, and 20-22 complete gestational weeks, respectively) and the modifications in diameter and volume of each uterine fibroid were recorded. A serial evaluation of hCG serum levels from 5-12 weeks was performed., Result(s): From the 109 women who fulfilled the study inclusion/exclusion criteria, a significant increase emerged, both for volume and diameter of the detected fibroids. Specifically, a median growth rate (GR) of 122% was observed during the interval of the first to the second ultrasound, whereas a median GR of 108% was detected during the interval between the second and the third ultrasound, and a median GR of 25% between the third and the fourth ultrasound. A significant positive correlation between hCG levels and diameter (R = 0.69) of myomas between 5 and 12 weeks emerged., Conclusion(s): A remarkable nonlinear growth of small fibroids during initial pregnancy was observed, with a faster rate in the first trimester and a slowdown by midpregnancy. Those changes seem to be related to the similar increase of hCG levels until 12 weeks., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The aim of the present study was to determine the association between the thickness of preperitoneal fat (PFT), utilized as an indicator of visceral fat deposition, and the risk of premalignant and malignant changes of endometrial polyps (EPs) in overweight and obese women. Overweight and obese women who had undergone diagnostic outpatient hysteroscopy and subsequent endometrial polypectomy between January 2010 and May 2013 were analyzed. Each patient underwent a transabdominal ultrasound for the purpose of measuring the thickness of preperitoneal fat. A total of 146 overweight or obese women were analyzed. The overall incidence of malignant or premalignant lesions was 8.2%. Notably, 5 patients (3.4%) received a histopathological diagnosis of complex hyperplasia with atypia, while polyps harboring carcinoma were diagnosed in 7 cases (4.8%). A significantly increased PFT was observed in women exhibiting preneoplastic and neoplastic lesions, compared with women with benign EPs (mean ± SD, 23.2±3.7 vs. 15.9±8.3; P<0.01). Patient age of >60 years was significantly associated with malignant progression of EPs, while body mass index, menopausal status, arterial hypertension, diabetes, abnormal uterine bleeding, hormone replacement therapy and tamoxifen treatment demonstrated no significant association with the development of preneoplastic and neoplastic lesions of the endometrium. In a multivariate analysis, only PFT maintained a significant correlation with the diagnosis of preneoplastic and neoplastic lesions on EPs (odds ratio, 1.14; 95% confidence interval, 1.04-1.26). Ultrasound evaluation of PFT in overweight and obese women may be useful for the identification of a particularly high-risk subgroup of women. Therefore, regardless of symptoms or additional clinical variables, these particularly high-risk women require appropriate counseling and prompt surgical removal of EPs.

We aimed to evaluate glycodelin immunostaining in pregnant women with a first diagnosis of cervical intraephitelial neoplasia (CIN) and to correlate the expression of CIN with Ki-67 and glycodelin immunostaining. A retrospective case-control study was performed including 20 patients with natural pregnancy and with first time onset of CIN occurring not later than 16 gestational weeks. The control group included 20 non-pregnant patients matched for age, parity, smoking status and number of previous sexual partners. Exclusion criteria included previous cervical treatment, immunocompromised status and chronic hepatitis B and/or C. Staining for Glycodelin and for Ki-67 was expressed using a classification based on the distribution of positivity on a semi-quantitative three-point scale. An inverse relationship was observed between glycodelin immunostaining and CIN grade in pregnant patients (p = 0.01), with a significantly higher expression in CIN1 than in CIN2 and CIN3, but not in non-pregnant patients (p = 0.81). Positivity for Ki-67 was less intense in pregnant than in non-pregnant patients. A significant inverse relationship was observed between glycodelin immunostaining and Ki-67 expression (p = 0.02). We suggest that the higher expression of glycodelin in pregnancy is related to a lower proliferative activity in CIN, which is probably associated to hormonal status of pregnancy. Further clinical studies are needed to support these findings.

Background: Chronic diseases are the major cause of death (59%) and disability worldwide, representing 46% of global disease burden. According to the Future Hospital Commission of the Royal College of Physicians, Medical Division (MD) will be responsible for all hospital medical services, from emergency to specialist wards. The Hospital Acute Care Hub will bring together the clinical areas of the MD that focus on the management of acute medical patients. The Chronic Care Model (CCM) places the patient at the center of the care system enhancing the community's social and health support, pathways and structures to keep chronic, frail, poly-pathological people at home or out of the hospital. The management of such patients in the hospital still needs to be solved. Hereby, we propose an innovative model for the management of the hospital's acute complex patients, which is the hospital counterpart of the CCM., Acute Complex Care Model (accm): The target population are acutely ill complex and poly-pathological patients (AICPPs), admitted to hospital and requiring high technology resources. The mission is to improve the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patient-centered approach. The ACCM leader is an internal medicine specialist (IMS) who summarizes health problems, establishes priorities, and restores health balance in AICPPs., Conclusions: The epidemiological transition leading to a progressive increase in "chronically unstable" and complex patients needing frequent hospital treatment, inevitably enhances the role of hospital IMS in the coordination and delivery of care. ACCM represents a practical response to this epochal change of roles., (Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Purpose of Investigation: The risk of endometrial cancer in women with endometrial polyps (EPs) has been reported to vary between 0.3% and 4.8%. There is a lack of data about the management of asymptomatic women with incidental diagnosis of EPs. In the present study the authors correlated demographic and clinical characteristics with histopathological features of the EPs hysteroscopically removed., Materials and Methods: An observational multi-institutional cohort study was conducted from February 2010 to December 2012 to identify all the premenopausal and postmenopausal women consecutively undergoing hysteroscopic polypectomy. The data of women were reviewed and clinical features were related to histopathologic results., Results: The patients recruited were 813. The mean age was 52.5 years (range 22-87). The results showed a correlation between older age, high body mass index (BMI) and obesity, postmenopausal state, abnormal uterine bleeding (AUB), hypertension, and risk of malignant EPs. On multivariable analysis, the correlation remained only for age (OR 1.08, 95% CI 1.03 - 1.14) and AUB (OR 3.53, 95% CI 1.87 - 6.65)., Conclusion: Older patients in postmenopausal status with AUB, a high BMI, and hypertension are at higher risk for premalignant and malignant polyps. In these patients a surgical approach should be used, consisting in hysteroscopical removing of the polyp.

Time scales of turbulent strain activity, denoted as the strain persistence times of first and second order, are obtained from time-dependent expectation values and correlation functions of Lagrangian rate-of-strain eigenvalues taken in particularly defined statistical ensembles. Taking into account direct numerical simulation data, our approach relies on heuristic closure hypotheses which allow us to establish a connection between the statistics of vorticity and strain. It turns out that softly divergent prefactors correct the usual "1/s" strain time-scale estimate of standard turbulence phenomenology, in a way which is consistent with the phenomenon of vorticity intermittency.

Idiopathic nephrotic syndrome (INS) is characterized by diffuse foot process effacement on electron microscopy and minimal changes (called minimal change nephropathy [MCN]), focal segmental glomerular sclerosis (FSGS), or the mesangial variant with proliferation on light microscopy. No evidence of immune deposits is seen. MCN is the most common form of INS in children and is sensitive to corticosteroid therapy in 90% of cases. FSGS accounts for 20-30% of biopsy-proven glomerulopathies in adult patients. Fifty percent of drug-resistant patients develop terminal renal failure in 6-8 years. Moreover, FSGS reappears in 15-50% of cases after the first transplant and in a higher percentage after the second graft. Genetic forms of INS, with mutation of the NPHS1 and NPHS2 genes encoding nephrin and podocin, are mostly steroid resistant and very rarely recur in the transplant. On the basis of any clinical pattern they are indistinguishable from idiopathic forms. Sera from patients with FSGS may contain some proteinuric or permeability factors (PFs), which have been partially identified and are predictive of recurrence in kidney grafts. Removal of PFs by means of plasmapheresis or plasma immunoadsorption by protein A or LDL apheresis has been associated with proteinuria reduction in cases of FSGS both of native and transplanted kidneys, in small series or cohort studies described by many authors. In this review of the main studies we will analyze the results of the apheretic treatments and the role of some clinical, serological and histological parameters in determining the outcome of patients.

We solve the Chapman-Kolmogorov equation and study the exact splitting probabilities of the general stochastic process which describes polymer translocation through membrane pores within the broad class of Markov chains. Transition probabilities, which satisfy a specific balance constraint, provide a refinement of the Chuang-Kantor-Kardar relaxation picture of translocation, allowing us to investigate finite size effects in the evaluation of dynamical scaling exponents. We find that (i) previous Langevin simulation results can be recovered only if corrections to the polymer mobility exponent are taken into account and (ii) the dynamical scaling exponents have a slow approach to their predicted asymptotic values as the polymer's length increases. We also address, along with strong support from additional numerical simulations, a critical discussion which points in a clear way the viability of the Markov chain approach put forward in this work.

Background: Oxidative stress is prevalent in dialysis patients and has been implicated in the pathogenesis of cardiovascular disease and anemia. Vitamin E is a fat-soluble antioxidant that plays a central role in reducing lipid peroxidation and inhibiting the generation of reactive oxygen species. The aim of this cross-over randomized study was to compare the effects of a vitamin E-coated polysulfone (Vit E PS) membrane and a non-vitamin E-coated polysulfone (PS) membrane on inflammatory markers and resistance to erythropoietin-stimulating agents (ESAs)., Methods: After a 1-month run-in period of standard bicarbonate dialysis with a synthetic membrane, 62 patients of both genders, and older than 18 years, dialysis vintage 48 ± 27 months, BMI 22 ± 3 (from 13 different dialysis units) were randomized (A-B or B-A) in a cross-over design to Vit E PS (treatment A) and to PS (treatment B) both for 6 months. C-reactive protein (CRP) and interleukin-6 (IL-6) concentrations were determined by a sandwich enzyme immunoassay at baseline and every 2 months; red blood cell count, ESA dose and ESA resistance index (ERI) were assessed monthly., Results: Hemoglobin (Hb) levels significantly increased in the Vit E PS group from 11.1 ± 0.6 g/dl at baseline to 11.5 ± 0.7 at 6 months (p < 0.001) and remained unchanged in the PS group. Although ESA dosage remained stable during the observation periods in both groups, ERI was significantly reduced in the Vit E PS group from 10.3 ± 2.2 IU-dl/kg/g Hb week at baseline to 9.2 ± 1.7 at 6 months (p < 0.001). No significant variation of ERI was observed in the PS group. A significant reduction in plasma CRP and IL-6 levels was observed in the Vit E PS group: CRP from 6.7 ± 4.8 to 4.8 ± 2.2 mg/l (p < 0.001) and IL-6 from 12.1 ± 1.4 to 7.5 ± 0.4 pg/ml (p < 0.05). In the PS group, CRP varied from 6.2 ± 4.0 to 6.4 ± 3.7, and IL-6 from 10.6 ± 2.1 to 9.6 ± 3.5 (p = n.s.)., Conclusions: Treatment with Vit E PS membranes seems to lead to a reduction in ESA dosage in HD patients; in addition, a low chronic inflammatory response may contribute to a sparing effect on exogenous ESA requirements., (Copyright © 2011 S. Karger AG, Basel.)

Stochastic partial differential equations can be used to model second-order thermodynamical phase transitions, as well as a number of critical out-of-equilibrium phenomena. In (2+1) dimensions, many of these systems are conjectured (and some are indeed proved) to be described by conformal field theories. We advance, in the framework of the Martin-Siggia-Rose field-theoretical formalism of stochastic dynamics, a general solution of the translation Ward identities, which yields a putative conformal energy-momentum tensor. Even though the computation of energy-momentum correlators is obstructed, in principle, by dimensional reduction issues, these are bypassed by the addition of replicated fields to the original (2+1)-dimensional model. The method is illustrated with an application to the Kardar-Parisi-Zhang (KPZ) model of surface growth. The consistency of the approach is checked by means of a straightforward perturbative analysis of the KPZ ultraviolet region, leading, as expected, to its c=1 conformal fixed point.

The Log-Poisson phenomenological description of the turbulent energy cascade is evoked to discuss high-order statistics of velocity derivatives and the mapping between their probability distribution functions at different Reynolds numbers. The striking confirmation of theoretical predictions suggests that numerical solutions of the flow obtained at low/moderate Reynolds numbers can play an important quantitative role in the analysis of experimental high Reynolds number phenomena, where small scales fluctuations are in general inaccessible from direct numerical simulations.

We discuss an elementary model of a turbulent boundary layer over a flat surface given as a vertical random distribution of spanwise Lamb-Oseen vortex configurations placed over a nonslip boundary-condition line. We are able to reproduce several important features of realistic flows, such as the viscous and logarithmic boundary sublayers, and the general behavior of the first statistical moments (turbulent intensity, skewness, and flatness) of the streamwise velocity fluctuations. As an application, we advance some heuristic considerations on the boundary layer underlying kinematics that could be associated with the phenomenon of drag reduction by polymers, finding a suggestive support from its experimental signatures.

A Lagrangian approach to Burgers turbulence is carried out along the lines of the field theoretical Martin-Siggia-Rose formalism of stochastic hydrodynamics. We derive, from an analysis based on the hypothesis of unbroken Galilean invariance, the asymptotic form of the probability distribution function of negative velocity differences. The origin of Burgers intermittency is found to rely on the dynamical coupling between shocks, identified to instantons, and noncoherent background fluctuations, which-then-cannot be discarded in a consistent statistical description of the flow.

We find actual evidence, relying upon vorticity time series taken in a high-Reynolds-number atmospheric experiment, that to a very good approximation the surface boundary layer flow may be described, in a statistical sense and under certain regimes, as an advected ensemble of homogeneous turbulent systems, characterized by a log-normal distribution of fluctuating intensities. Our analysis suggests that the usual direct numerical simulations of homogeneous and isotropic turbulence, performed at moderate Reynolds numbers, may play an important role in the study of turbulent boundary layer flows, if supplemented with appropriate statistical information concerned with the structure of large-scale fluctuations.

With the aim of investigating the capability of otoacoustic emission (OAE) in the detection of low levels of noise-induced hearing loss, audiometric and otoacoustic data of young workers (age: 18-35) exposed to different levels of industrial noise have been recorded. These subjects are participating in a long-term longitudinal study, in which audiometric, exposure (both professional and extra-professional), and OAE data (transient evoked and distortion product) will be collected for a period of several years. All measurements have been performed, during routine occupational health surveillance, with a standard clinical apparatus and acquisition procedure, which can be easily used in the occupational safety practice. The first study was focused on the correlation between transient evoked OAE signal-to-noise ratio and distortion product (DPOAE) OAE level and the audiometric threshold, investigating the causes of the rather large intersubject variability of the OAE levels. The data analysis has shown that, if both OAE data and audiometric data are averaged over a sufficiently large bandwidth, the correlation between DPOAE levels and audiometric hearing threshold is sufficient to design OAE-based diagnostic tests with good sensitivity and specificity also in a very mild hearing loss range, between 10 and 20 dB.

Introduction: Although several registries collecting data of patients with kidney diseases exist, only a few specifically collect data relating to renal biopsy. Kidney biopsy has been performed routinely in Pisa since 1977; the aim of this study was to report the relative frequency of nephropathies according to gender, age at time of biopsy, clinical presentation and renal function, based on histological diagnoses during the years 1977 through 2005. During this time, 3,810 kidney biopsies were performed, of which 89.3% were from native (n=3,446) and 10.7% from transplant kidneys. Throughout this period, 5% of renal biopsies were not diagnostic, so in this paper we report data regarding 3,269 native kidney nephropathies., Methods: During the years 1977 through 2005, data for renal biopsies were collected on specific registers filled out by clinicians. Information collected in the database included a variety of indicators, such as clinical anamnesis, creatinine clearance, daily proteinuria, hemoglobin levels, blood pressure, height and weight, clinical presentation, and current medications. Clinical presentation was defined as urinary abnormalities (UA), nephrotic syndrome (NS) and acute nephritic syndrome (ANS). Renal diseases were divided into 4 major categories: primary glomerulonephritis (GN), secondary GN, tubulointerstitial nephropathies (TIN) and vascular nephropathies (VN)., Results: From 1977 up to 1987, a mean of 95 +/- 18 renal biopsies/year were performed; this number significantly increased to 185 +/- 22 renal biopsies/year (range 138-200) (p<0.001) in the following period (1988-2005). Renal biopsy was more frequently performed in males (59%) compared with females (41%). Of all diseases of the native kidney, primary GN was the most frequent (66%), followed by secondary GN (25.6%), TIN (4.2%) and VN (4.2%). The type of primary GN with the highest frequency was mesangial GN (both IgA and non-IgA) (45.7%), followed by membranous GN (23%), focal segmental glomerulosclerosis (19.8%), minimal change disease (5.3%), crescentic GN (4.2%) and postinfectious GN (2%). In terms of age, renal biopsy was more frequently performed in patients aged 20 to 60 years, and nearly 60% of patients presented a glomerular filtration rate (GFR) >60 ml/min at the time of biopsy. The main clinical reason for performing renal biopsy was UA, in all the types of nephropathies., Conclusions: We confirm data that renal diseases are more frequent in men, with the exception of secondary GN. The mean age at diagnosis was 42 years resulting from the tendency not to perform renal biopsies in children and in elderly patients. Renal biopsy was mainly performed in patients with GFR >60 ml/min and asymptomatic urinary abnormalities suggesting concern on the part of clinicians regarding glomerular diseases. The tendency to perform renal biopsies has been significantly increasing throughout our follow-up period.

Background: Mixed cryoglobulinemia is a multisystem disorder associated strongly with hepatitis C virus (HCV) infection. The kidney frequently is involved, and glomerulonephritis represents the key factor affecting prognosis., Methods: Clinical, serological, immunogenetic, and morphological data were collected retrospectively from medical records of 146 patients with cryoglobulinemic glomerulonephritis who underwent biopsies in 25 Italian centers and 34 cryoglobulinemic controls without renal involvement., Results: Eighty-seven percent of patients were infected with HCV; genotype 1b was more frequent than genotype 2 (55% versus 43%). Diffuse membranoproliferative glomerulonephritis was the most prevalent histological pattern (83%). Type II cryoglobulin (immunoglobulin Mkappa [IgMkappa]/IgG) was detected in 74.4% of cases. The remainder had type III (polyclonal IgM/IgG) cryoglobulins. A multivariate Cox proportional hazard model showed that age, serum creatinine level, and proteinuria at the onset of renal disease were associated independently with risk for developing severe renal failure at follow-up. Overall survival at 10 years was about 80%. Kaplan-Meier survival curves were worsened by a basal creatinine value greater than 1.5 mg/dL (>133 mumol/L), but were unaffected by sex and HCV infection. Cardiovascular disease was the cause of death in more than 60% of patients., Conclusion: Data confirm the close association between mixed cryoglobulinemia and HCV infection and between glomerulonephritis and type II cryoglobulin. Survival profiles are better than previously reported in the literature, probably because of improvement in therapeutic regimens. Causes of death reflect this improvement in survival, with an increased prevalence of cardiovascular events compared with infectious complications and hepatic failure, which were predominant in the past.

The 2004 SIN census of the Italian nephrology and dialysis centres showed many interesting data about the epidemiology and the organization in the Regions of Emilia-Romagna (ER) and Tuscany (T). A) Epidemiology: incidence of dialysis patients 169 pmp (patients per million population) in ER, 147 ppm in T; prevalence of dialysis patients 639 pmp and 665 pmp, respectively; prevalence of transplanted patients 325 ppm in ER and 233 pmp in T; gross mortality of dialysis patients 16.3% and 13.4%, respectively; B) Type of vascular access in prevalently dialysis patients: arteriovenous fistula 83% and 78%; central venous catheter 13% and 12%; vascular graft 5% and 9%. C) Structural resources: nephrology beds 44 mp (per million population) and 50 mp; dialysis places 157 and 146 mp. D) Personnel resources : renal physicians 29 and 41 mp; renal nurses 171 and 202 mp ; each renal physician cares for 22 and 16 dialysis patients, and each renal nurse takes care of 3.7 and 3.3 dialysis patients. E) Activity: hospital admissions 1572, 1769 pmp; renal biopsies 115 and 166 pmp.

In the last few years the Italian Society of Nephrology has addressed many technical-scientific and management aspects to better patient satisfaction. Project No. 1 of the 2004-2006 programme on 'Quality and Accreditation of National Renal Units' focuses on four essential points. The first is the questionnaire mailed to all the Presidents and Regional Delegates on the relationship between Nephrology units, Local Government Health-System and the Regional Healthcare Agency. The results evidence that the 'political' decision-making power of nephrologists decreases in the absence of a national strategy. The second point, in collaboration with the National Census Group, includes the quality analysis and the standardization of resources (human and structural) and management of the Renal Units. The third point is based on 'Educational Courses for Quality and Accreditation' held in Rome (3-5 October 2005: L'Accreditamento all'Eccellenza dell'Unita' Operativa di Nefrologia, Dialisi e Trapianto; 17-19 October 2005: Il Manuale di Accreditamento della Specialità di Nefrologia). The courses aim at training members responsible for each region to hold courses in their specific region to create a network including each single Renal Unit to create an acceptable homogenous language on the models of analysis and on the correct use of 'The Guide for Excellence Accreditation'. The fourth point concerns both the on-line Guide for Excellence Accreditation and 'Peer Review Accreditation' and the NEQUASY (Nephrology Quality System) project. The manual must be 'user friendly' allowing each Centre to self-evaluate using national and regional standards.

A large class of quantum and statistical field theoretical models, encompassing relevant condensed matter and non-Abelian gauge systems, are defined in terms of complex actions. As the ordinary Monte Carlo methods are useless in dealing with these models, alternative computational strategies have been proposed along the years. The Langevin technique, in particular, is known to be frequently plagued with difficulties such as strong numerical instabilities or subtle ergodic behavior. Regarding the chirally decomposed version of the sine-Gordon model as a prototypical case for the failure of the Langevin approach, we devise a truncation prescription in the stochastic differential equations which yields numerical stability and is assumed not to spoil the Berezinskii-Kosterlitz-Thouless transition. This conjecture is supported by a finite size scaling analysis, whereby a massive phase ending at a line of critical points is clearly observed for the truncated stochastic model.

A dual lattice vortex formulation of homogeneous turbulence is developed, within the Martin-Siggia-Rose field theoretical approach. It consists of a generalization of the usual dipole version of the Navier-Stokes equations, known to hold in the limit of vanishing external forcing. We investigate, as a straightforward application of our formalism, the dynamics of closed vortex tubes, randomly stirred at large length scales by Gaussian stochastic forces. We find that besides the usual self-induced propagation, the vortex tube evolution may be effectively modeled through the introduction of an additional white-noise correlated velocity field background. The resulting phenomenological picture is closely related to observations previously reported from a wavelet decomposition analysis of turbulent flow configurations.