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The purpose of this work was to determine the influence of myocardial wringing on ventricular function in patients with cardiac amyloidosis (CA).Fifteen healthy volunteers (group 1) and 34 patients with CA (17 with left ventricular ejection fractions [LVEFs] ≥ 53% [group 2] and 17 with LVEFs 53% [group 3]) were evaluated using two-dimensional speckle-tracking echocardiography. A control group of mass-matched patients (n = 20) with left ventricular (LV) hypertrophy and LVEFs ≥ 53% was also included. Longitudinal strain (LS), circumferential strain, and LV twist and torsion were calculated. Deformation index (DefI), a new parameter of wringing, calculated as twist/LS, that takes into account actions that occur simultaneously during LV systole (i.e., longitudinal shortening and twist), was evaluated. Torsional and wringing parameters were calculated according to LVEF.Lower global values of LS and circumferential strain were observed among patients with CA (LS: group 1, -20.6 ± 2.5%; group 2, -11.6 ± 4.1%; group 3, -9.0 ± 3.1%; circumferential strain: group 1, -22.7 ± 4.9%; group 2, -14.4 ± 8.0%; group 3, -13.6 ± 3.8%; P .001 for both). Torsion did not vary between group 2 and group 1 (2.5 ± 1.1°/cm vs 2.7 ± 0.8°/cm, P = NS). In contrast, DefI was greater in group 2 than in group 1 (-1.8 ± 0.8°/% vs -1.0 ± 0.3°/%, P .01). Torsion and DefI were lower in group 3 (1.2 ± 0.7°/cm and -1.1 ± 0.6°/%, respectively, P .001 for both) than in group 2. DefI was similar in patients with LV hypertrophy (-1.7 ± 0.6°/%, P = NS) and group 2.In patients with CA, preservation of LVEF depends on greater ventricular wringing. DefI, a parameter that integrates the twist and the simultaneous longitudinal shortening of the left ventricle, is a more accurate indicator of the efficacy of this mechanism.

The peculiar combined, or binary involvement of epithelium and stroma makes basal cell carcinoma (BCC) a unique tumour. Nerve fibres have been shown to play an active role in different cancers. A prospective observational study was carried out on punch biopsies harvested within BCC surgical excision specimens. A total of 10 samples of histologically diagnosed BCC, derived from 10 different patients (five females, five males), was included in the study. Within the BCCs, seven different histological sub-types were identified: morphea-like, basosquamous, micronodular, mixed nodular-micronodular, adenoid, nodular and superficial multifocal. Nerve fibres were stained for indirect immunofluorescence targeting protein gene product 9.5. Three different morphological patterns of nerve fibre distribution within the BCCs were identified. Pattern 1 displayed a normal skin nerve pattern, in which the fibres were dislodged by the growing tumour masses. Pattern 2 featured a ball of curved, tangled nerve fibres close to the tumour masses, slightly resembling piloneural collar nerve fibres, wrapped around hair follicles in the normal anatomical setting. Pattern 3 showed nerve fibres crowding in the sub-epidermal layer with focal epidermal hyperinnervation. Such a pattern is reminiscent of the typical anatomical neuro-epithelial interaction in mechanosensory organs. Our study may disclose a hidden third player, of nerves. Thus, tissue involvement of BCCs may be better represented by the triad of epithelium, stroma and nerves, each component retaining some features associated with its developmental setting.

Anemia is a common complication of chronic kidney disease (CKD). The prevalence of anemia in CKD strongly increases as the estimated Glomerular Filtration Rate (eGFR) decreases. The pathophysiology of anemia in CKD is complex. The main causes are erythropoietin (EPO) deficiency and functional iron deficiency (FID). The administration of injectable preparations of recombinant erythropoiesis-stimulating agents (ESAs), especially epoetin and darbepoetin, coupled with oral or intravenous(iv) iron supplementation, is the current treatment for anemia in CKD for both dialysis and non-dialysis patients. This approach reduces patients’ dependence on transfusion, ensuring the achievement of optimal hemoglobin target levels. However, there is still no evidence that treating anemia with ESAs can significantly reduce the risk of cardiovascular events. Meanwhile, iv iron supplementation causes an increased risk of allergic reactions, gastrointestinal side effects, infection, and cardiovascular events. Currently, there are no studies defining the best strategy for using ESAs to minimize possible risks. One class of agents under evaluation, known as prolyl hydroxylase inhibitors (PHIs), acts to stabilize hypoxia-inducible factor (HIF) by inhibiting prolyl hydroxylase (PH) enzymes. Several randomized controlled trials showed that HIF-PHIs are almost comparable to ESAs. In the era of personalized medicine, it is possible to envisage and investigate specific contexts of the application of HIF stabilizers based on the individual risk profile and mechanism of action.

Highlights • We found rVSVΔG-ZEBOV-GP to be immunogenic at 28- and 180-days post vaccination. • At 28 days post-vaccination, seroresponse rate was higher in the high-risk group. • There is a significant pairwise correlation at 28 days post-vaccination between assays. • One dose of rVSVΔG-ZEBOV-GP induces a cellular response that increased with time., Background As part of a Phase III trial with the Ebola vaccine rVSVΔG-ZEBOV-GP in Guinea, we invited frontline workers (FLWs) to participate in a sub-study to provide additional information on the immunogenicity of the vaccine. Methods We conducted an open‐label, non‐randomized, single-arm immunogenicity evaluation of one dose of rVSVΔG-ZEBOV-GP among healthy FLWs in Guinea. FLWs who refused vaccination were offered to participate as a control group. We followed participants for 84 days with a subset followed-up for 180 days. The primary endpoint was immune response, as measured by ELISA for ZEBOV-glycoprotein–specific antibodies (ELISA-GP) at 28 days. We also conducted neutralization, whole virion ELISA and enzyme-linked immunospot (ELISPOT) assay for cellular response. Results A total of 1172 participants received one dose of vaccine and were followed-up for 84 days, among them 114 participants were followed-up for 180 days. Additionally, 99 participants were included in the control group and followed up for 180 days. Overall, 86.4% (95% CI 84.1–88.4) of vaccinated participants seroresponded at 28 days post-vaccination (ELISA- GP) with 65% of these seroresponding at 14 days post-vaccination. Among those who seroresponded at 28 days, 90.7% (95% CI 82.0–95.4) were still seropositive at 180 days. The proportion of seropositivity in the unvaccinated group was 0.0% (95% CI 0.0–3.8) at 28 days and 5.4% (95% CI 2.1–13.1) at 180 days post-vaccination. We found weak correlation between ELISA-GP and neutralization at baseline but significant pairwise correlation at 28 days post-vaccination. Among samples analysed for cellular response, only 1 (2.2%) exhibited responses towards the Zaire Ebola glycoprotein (Ebola GP ≥ 10) at baseline, 10 (13.5%) at day 28 post-vaccination and 27 (48.2%) at Day 180. Conclusions We found one dose of rVSVΔG-ZEBOV-GP to be highly immunogenic at 28- and 180-days post vaccination among frontline workers in Guinea. We also found a cellular response that increased with time.

Aims Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects morbidity and mortality in CHF patients. Methods and Results The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance, and the presence of diabetes were evaluated. A MHDS was defined as the presence of ≥2 hormone deficiencies (HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred and eighty heart failure patients with ejection fraction ≤45% were enrolled. MHDS or diabetes was diagnosed in 372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded, 41% in NO-MHDS and 62% in MHDS (P Conclusion MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular hospitalization, representing a promising therapeutic target. Trial registration ClinicalTrials.gov identifier: NCT023358017

Chronic kidney disease (CKD) is a clinical condition characterized by high morbidity and mortality. Globally, CKD is also increasing in prevalence and incidence. The two principal kidney measures namely estimated glomerular filtration rate (eGFR) and albuminuria have been found to be predictors of renal and cardiovascular (CV) endpoints including peripheral artery disease (PAD). The prevalence of PAD was increased in CKD patients and, particularly, in patients with more severe CKD stages. Despite the fact that revascularization strategies are suitable in CKD patients in similar fashion to non-CKD patients, few CKD patients underwent these procedures. In fact, if it is true that revascularization improves prognosis in PAD patients irrespective of baseline eGFR, it was also demonstrated that CKD patients, who underwent revascularization, were at higher risk for amputations, mortality, re-intervention and perioperative complications. With the present review article, we have examined the association between CKD, PAD and peripheral revascularization highlighting data about epidemiology, pathophysiologic mechanisms, and results from previous observational and intervention studies. We have also examined the future perspectives and challenges of research around the association between CKD and PAD.

Metalloproteinases (MPs) are proteolytic enzymes involved in extracellular matrix deposition, regulation of cellular signals of inflammation, proliferation, and apoptosis. Metalloproteinases are classified into three families: Matrix-MPs (MMPs), A-Disintegrin-and-Metalloprotease (ADAMs), and the A-Disintegrin-and-Metalloproteinase-with-Thrombospondin-1-like-Domains (ADAMTS). Previous studies showed that MPs are involved in the development of aortic aneurysms (AA) and, concomitantly, in the onset of chronic kidney disease (CKD). CKD has been, per se, associated with an increased risk for AA. The aim of this review is to examine the pathways that may associate MPs with CKD and AA. Several MMPs, such as MMP-2, -8, -9, and TIMP-1 have been shown to damage the AA wall and to have a toxic effect on renal tubular cells, leading to fibrosis. Similarly, ADAM10 and 17 have been shown to degrade collagen in the AA wall and to worsen kidney function via pro-inflammatory stimuli, the impairment of the Renin-Angiotensin-Aldosterone System, and the degradation of structural proteins. Moreover, MMP-2 and -9 inhibitors reduced aneurysm growth and albuminuria in experimental and human studies. It would be important, in the future, to expand research on MPs from both a prognostic, namely, to refine risk stratification in CKD patients, and a predictive perspective, likely to improve prognosis in response to targeted treatments.

BackgroundHigh ultrasound renal resistive index (RI) predicts poor cardiorenal outcomes in chronic kidney disease (CKD) and has recently emerged as a marker of nephroprotective drugs response. Thus, having a risk profile of CKD patients with abnormal RI may be relevant for the clinicians.MethodsConsecutive patients referred to our non-dialysis CKD clinic from 01/01/2016 to 01/12/2016, were evaluated by clinical and ultrasound analysis. Inclusion criteria were age >18 years and presence of CKD defined as estimated glomerular filtration rate (eGFR)0.150g/24h. Renal artery stenosis, solitary kidney, acute kidney injury were the main exclusion criteria. RI value was the mean of three measures in segmental arteries in each kidney. Univariate analysis was performed to evaluate associations between continuous RI and clinical variables. Multivariate linear regression analysis, based on stepwise method with an elimination criterion of pResultsWe studied 73 patients (69.9% men). Mean RI was 0.67±0.09. Frequencies of diabetes and cardiovascular disease (CVD) were 19.2% and 20.6% and median eGFR 54.1 [30.0-84.6] mL/min/1.73m2. From low (0.70) RI categories, eGFR and haemoglobin levels were decreased while diabetes, cardiovascular disease (CVD), phosphate and smokers were higher. At univariate analysis, RI was significantly associated with age, presence of diabetes, CVD, serum phosphorus, eGFR, Urea and haemoglobin. Multi-adjusted stepwise regression analysis showed that lower eGFR levels (pConclusionsThis analysis suggests that RI is higher in CKD patients with CVD, diabetes, smoking habit and higher serum phosphorus, regardless of eGFR. Further studies are needed to verify whether higher RI indicates more complex pathway of intrarenal damage, besides and beyond kidney function.

This contribution presents experimentation of research on urban accessibility applying to professional consultancy work, done by the Department of Civil, Architectural and Environmental Engineering of the University of Naples Federico II, for the city of Cercola (NA) to support the edit of the City Master Plan. One of the more complex challenges in urban planning is the poor connection between the transport system and the land-use pattern, which encouraged the use of the private car as the first means of transport, polluting and overcrowding urban areas. In this study, we propose the application of Node-Place method at the station level to improve the urban quality of life, safety and economic condition. The city of Cercola is in the periurban area of Naples, through the application of Node and Place model at the local scale, we defined the potential solutions to make the city more accessible and the definition of sustainable mobility solutions.

Chronic Kidney Disease (CKD) represents a risk factor for fatal and nonfatal cardiovascular (CV) events, including peripheral vascular disease (PVD). This occurs because CKD encompasses several factors that lead to poor prognoses, mainly due to a reduction of the estimated glomerular filtration rate (eGFR), the presence of proteinuria, and the uremic inflammatory milieu. The matrix metalloproteinases (MMPs) are a group of zinc-containing endopeptidases implicated in extracellular matrix (ECM) remodeling, a systemic process in tissue homeostasis. MMPs play an important role in cell differentiation, angiogenesis, inflammation, and vascular damage. Our aim was to review the published evidence regarding the association between MMPs, PVD, and CKD to find possible common pathophysiological mechanisms. MMPs favor ECM deposition through the glomeruli, and start the shedding of cellular junctions and epithelial-mesenchymal transition in the renal tubules. MMP-2 and -9 have also been associated with the presence of systemic vascular damage, since they exert a pro-inflammatory and proatherosclerotic actions. An imbalance of MMPs was found in the context of PVD, where MMPs are predictors of poor prognoses in patients who underwent lower extremity revascularization. MMP circulating levels are increased in both conditions, i.e., that of CKD and PVD. A possible pathogenic link between these conditions is represented by the enhanced production of transforming growth factor-β that worsens vascular calcifications and atherosclerosis and the development of proteinuria in patients with increased levels of MMPs. Proteinuria has been recognized as a marker of systemic vascular damage, and this may explain in part the increase in CV risk that is manifest in patients with CKD and PVD. In conclusion, MMPs can be considered a useful tool by which to stratify CV risk in patients with CKD and PVD. Further studies are needed to investigate the causal-relationships between MMPs, CKD, and PVD, and to optimize their prognostic and predictive (in response to treatments) roles.

The aim of the study was the objective assessment of the effectiveness of a microfragmented dermal extract obtained with Rigenera™ technology in promoting the wound healing process in an in vivo homogeneous experimental human acute surgical wound model. The study included 20 patients with 24 acute postsurgical soft tissue loss and a planned sequential two-stage repair with a dermal substitute and an autologous split-thickness skin graft. Each acute postsurgical soft tissue loss was randomized to be treated either with an Integra® dermal substitute enriched with the autologous dermal micrografts obtained with Rigenera™ technology (group A—Rigenera™ protocol) or with an Integra® dermal substitute only (group B—control). The reepithelialization rate in the wounds was assessed in both groups at 4 weeks through digital photography with the software “ImageJ.” The dermal cell suspension enrichment with the Rigenera™ technology was considered effective if the reepithelialized area was higher than 25% of the total wound surface as this threshold was considered far beyond the expected spontaneous reepithelialization rate. In the Rigenera™ protocol group, the statistical analysis failed to demonstrate any significant difference vs. the controls. The old age of the patients likely influenced the outcome as the stem cell regenerative potential is reduced in the elderly. A further explanation for the unsatisfying results of our trial might be the inadequate amount of dermal stem cells used to enrich the dermal substitutes. In our study, we used a 1 : 200 donor/recipient site ratio to minimize donor site morbidity. The gross dimensional disparity between the donor and recipient sites and the low concentration of dermal mesenchymal stromal stem cells might explain the poor epithelial proliferative boost observed in our study. A potential option in the future might be preconditioning of the dermal stem cell harvest with senolytic active principles that would fully enhance their regenerative potential. This trial is registered with trial protocol number NCT03912675.

Background Ischaemic chest pain can be originated by different causes. Among all, coronary fistulas are rarely the reason. Such entities are usually asymptomatic and can be diagnosed by echocardiography or coronary angiography. In an even rarer scenario, coronary fistulas might dilate and form an aneurysm. Case summary We report the case of a 62-year-old patient who was initially referred to the emergency department for stable angina. Coronary angiography and computed tomography scan showed a giant aneurysm relating to a coronary fistula with a course from the circumflex coronary artery to the superior vena cava. The aneurysm was critically compressing the left anterior descending coronary artery. It was confirmed and resolved by surgery. Discussion Giant aneurysms of a coronary fistula are very uncommon entities. We describe a rare case of angina caused by extrinsic compression of the left anterior descending artery from a giant aneurysm of a coronary fistula.

AIM To compare the shaping ability of four instrumentation systems in curved molar root canals, using computerized microtomography (micro-CT). METHODOLOGY Forty mesial roots of mandibular molars were submitted first to radiographic examination to determine their curvature and then to a micro-CT scan to analyse other initial morphological characteristics. The specimens were distributed into four experimental groups, according to the endodontic instrumentation system used (n = 10): Group R, Reciproc; Group PTN, ProTaper Next; Group WOG, WaveOne Gold; Group PDL, ProDesign Logic. After root canal instrumentation, the specimens were submitted to a second micro-CT scan, and the pre- and postoperative data were examined to evaluate the following parameters: volume of dentine removed (DR), increase in root canal volume (VI), untouched root canal surface area (UA), volume of accumulated hard tissue debris (AD) and structure model index (SMI). The data observed for these parameters after instrumentation were analysed using generalized linear models. R software was used for the analyses, and the level of significance adopted was 5%. RESULTS There were no significant differences among the instrumentation systems regarding the DR, VI, UA and AD parameters (P > 0.05). PTN and WOG systems were associated with greater increases in SMI than the PDL system (P

Many complexities arise in commercial transactions dealing in goods and products, which create liability under the different torts of conversion, detinue and trespass, although many of these circumstances also trigger liability under separate principles of contract or property law. Due to the constant conflicts in the application of these torts in case-law jurisprudence, many countries have consolidated the different principles of apportioning liability for product interference or interference with goods into a statutory tort of “wrongful interference with goods”. Nigeria is yet to adopt this approach. However, this paper concludes that the discordant application of the torts of conversion, detinue and trespass to goods in judicial decisions in Nigeria exposes a fundamental drawback that requires legislation to correct through the construction of a single unified tort of wrongful interference with goods.

Background and Aims Measurement of urine proteins, mainly through the 24-hour excretion or the albumin-to-creatinine ratio (ACR) has become crucial in current clinical practice in Nephrology. Besides being a biomarker of injury, albuminuria also exerts direct pro-inflammatory and pro-fibrotic effects on renal tubules. Hence, a large number of intervention studies have been aimed at lowering albuminuria levels in patients with Chronic Kidney Disease (CKD). However, albuminuria is a measure characterized by a random variability that has been evaluated in several mechanistic and experimental studies and may be influenced by several factors, such as posture, exercise and dietary factors. The aim of the present study was to evaluate the within-day variability, specifically in a cohort of CKD outpatients who were on Renin-Angiotensin-Aldosterone-System inhibitors (RAASi) therapy. Method We enrolled consecutive CKD patients referred to the Nephrology Unit at Magna Graecia University Hospital of Catanzaro between January 1st and March 30th 2020. Inclusion criteria were: age > 18 years, diagnosis of CKD from any cause, presence of albuminuria in the range 150-3500 mg/g at screening. Patients already treated with RAASi, patients with active malignancy/signs of glomerulonephritis requiring immunosuppressive therapies, were excluded. At screening visit, patients with increased albuminuria were started with an Angiotensin Converting Enzyme inhibitor (ACEi) or an Angiotensin II Receptor Blocker (ARB). A second ambulatory visit was scheduled 1 month after start of RAASi therapy. During this visit, patients were asked to stay in the Renal Unit for 12 hours. They collected urine void for ACR, protein-to-creatinine ratio (PCR) and urine creatinine (Ucreat) assessment at 8am,1pm and 6pm. For each patient, comparisons between ACR, PCR and Ucreat were assessed by Kruskal-Wallis test and Friedman post-hoc, using the Benjamini-Hochberg as adjustment method. Coefficients of variation (CV,standard deviation/mean) were also computed. Results Final analysis included 43 patients (46.5% of males). Mean age was 59.6±16.7 years and median eGFR 41 [21-74] mL/min/1.73m2. A high cardiovascular (CV) risk profile was testified by the prevalence of type 2 diabetes (30.2%) and previous CV disease (34.8%). When patient characteristics were compared across ACR categories (300 mg/g), systolic blood pressure was increased (p=0.020) and mean age decreased from 68.0 to 54.8 years on average (p=0.038). ACR values collected were 189 [38-759], 252 [51-1685] and 229 [56-1185] mg/g at 8am, 1pm and 6pm, respectively, with a CV of 24.6% (95%CI 12.4-39.1). 8am ACR was significantly different from 1pm ACR (p Conclusion The present analysis showed a significant individual within-day variability of albuminuria, measured as both ACR and PCR, suggesting that another parameter, in addition to those already known, may be responsible for the day-by-day albuminuria variation. Moreover, the absence of variability in Ucreat, namely the denominator of the ACR/PCR formula, suggests that the true variation is likely dependent on the urine protein values. Thus, albuminuria reduction in response to RAASi treatment should be carefully evaluated by measuring ACR/PCR preferentially at a similar time of the day for each patient. This would allow to avoid under- or overestimation of the actual treatment effect.

Precision health, by means of the support of precision medicine and precision nursing, is able to support clinical decision making in order to tailor optimal health-care decisions, around the individual characteristics of patients. The operational arm of precision health is represented by the use of biomarkers that can give useful information about disease susceptibility, exposure, evolution and response to treatment. Omics, imaging and clinical biomarkers are actually studied for their ability to positively impact health-care management. In this article, we try to address the role of biomarkers in the context of modern medicine and nursing with the view of improving patients care.

Background:. Traditionally, nonmelanoma skin cancers (NMSCs) are considered mainly UV-related malignancies. Nevertheless, a strong correlation between the embryologically relevant sites (ERS) of the head and neck and the preferential sites of onset of basal cell carcinomas (BCCs) has long been supposed and demonstrated. The aim of this research was the investigation of the potential correlation between the ERS of the head and neck and the sites of tumor onset in all of the NMSCs. Methods:. The distribution of 1165 NMSC was correlated with the ERS of the head and neck using the universally accepted anatomical diagrams featuring the congenital head and neck clefts and an original anatomical diagram showing the most credited sites of the embryonic fusion planes of the auricle. Results:. In our sample, both BCC and SSC display an increased likelihood of onset in the ERS of the head and neck. A proportion of 93.10% BCCs was distributed within ERS, while 6.90% derived from non-embryologically relevant sites (P < 0.001). A proportion of 69.70% SCCs was distributed within ERS, while 30.30% derived from non-embryologically relevant sites (P < 0.001). The probability of tumors within ERS was significantly higher for BCC versus SCC (P < 0.001), with BCCs having a 5-fold increase in the probability of occurring in ERS compared to SCCs (P < 0.001). Conclusions:. The ERS might host areas of cellular instability yielding to the development of an NMSC. The environmental UV exposure plays a relatively main role versus dysontogenic factors in the pathogenesis of SCC.

New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light on this issue, as they allow a comparison to be made between microbial presence and activity. Therefore, the aim of this single-arm intervention trial is to evaluate the antibacterial effect of endodontic procedures using both molecular methods. Root canal samples were obtained from 20 patients with asymptomatic apical periodontitis after each treatment step: access cavity, chemo-mechanical preparation, adjunctive procedures (XP-endo Finisher file and passive ultrasonic irrigation), calcium hydroxide medication, and 2nd-visit root canal preparation. DNA and cDNA from the samples were subjected to quantitative polymerase chain reaction with universal primers for the bacterial 16S rRNA gene. Chemo-mechanical preparation promoted a drastic reduction in bacterial levels and activity, whereas the adjunctive procedures did not make a significant contribution to further disinfection. At the 2nd visit, bacteria were active after the use of calcium hydroxide medication, however, they were significantly reduced after a 2nd-visit preparation. Consequently, the lowest bacterial levels were found at the end of the treatment. This clinical trial, which used an rRNA and rDNA combined approach, confirmed previous studies showing that root canal preparation represents the main strategy for root canal disinfection.

Introduction Aortic graft infections (AGI) can have catastrophic consequences with an operative mortality of nearly 50%. The majority of AGI are a result of bacterial exposure at the time of operation (surgical-site related), nearly three quarters a caused by the Staphylococcus organisms. Late onset infections are less common. The mechanism can be through hematogenous spread and bacterial invasion of the graft. Diagnosis is challenging, done by a combination of clinical, radiological and laboratory findings in which echocardiography plays an important role. Fundamental tenets of AGI management are removal of the infected device and adjunctive antimicrobial therapy. Case A 74-year-old man, who had undergone supracoronary ascending aortic replacement in 2015 for an aneurism, visited our hospital with fever of 39°, general malaise and abdominal pain for the last 3 days. He had been discharged one week ago after laparoscopic left colectomy due to descending colon neoplasia. Physical examination showed a systolic heart murmur loudest over the left-upper sternal border. Hematological findings included C-reactive protein (CRP) of 82 mg/l and white blood cell count of 16 700/μl. Blood culture was positive por Pseudomonas aeruginosa. Transthoracic echocardiography revealed a supravalvular pulmonary stenosis (figure 1, A) Transesophageal examination showed an extensive peritubular collection (figure 1, B) that extended into the main pulmonary artery, conditioning extrinsic compression and severe stenosis. No blood flow was observed inside the collection. A 6 mm long and filiform image was detected on the right coronary leaflet, causing a moderate aortic regurgitation. Chest CT revealed a low density area around the vascular graft (figure 1, C) and the positron emission tomography (PET)-CT (figure 1, D) showed increased glucidic metabolism in the aneurysmal sac, periaortic fat and the proximal and distal portion of the prosthesis. With the diagnosis of prosthetic vascular graft infection, the patient was referred to cardiac surgery. The surgical sample cultures (graft and mediastinal pus) were all positive for P. aeruginosa. The patient completed antibiotic therapy with ceftazidime and gentamicine. Discussion AGI is an extremely complex clinical challenge. Mortality is high, and diagnostic and treatment approaches are controversial. Cardiovascular imaging is one of the most important diagnostic tools in the diagnosis. An echocardiogram should be done in every patient to look for findings of endocarditis. CT is the most informative radiologic study and can be also very helpful in identifying characteristics and extension of AGI. A concurrent PET-CT study has significant potential in improving diagnosis of AGI and monitoring response to treatment.Nevertheless there is an unavoidable degree of subjective judgment in the interpretation of imaging findings making clinical suspicion and laboratory findings crucial in determining whether an AGI exists. Abstract P882 Figure.

Chronic kidney disease (CKD) is currently defined as the presence of proteinuria and/or aneGFR<60 mL/min/1.73m2on the basis of the renal diagnosis. The global dimension of CKD is relevant, since its prevalence and incidence have doubled in the past three decades worldwide. A major complication that occurs in CKD patients is the development of cardiovascular (CV) disease, being the incidence rate of fatal/nonfatal CV events similar to the rate of ESKD in CKD. Moreover, CKD is a multifactorial disease where multiple mechanisms contribute to the individual prognosis. The correct development of novel biomarkers of CV risk may help clinicians to ameliorate the management of CKD patients. Biomarkers of CV risk in CKD patients are classifiable as prognostic, which help to improve CV risk prediction regardless of treatment, and predictive, which allow the selection of individuals who are likely to respond to a specific treatment. Several prognostic (cystatin C, cardiac troponins, markers of inflammation, and fibrosis) and predictive (genes, metalloproteinases, and complex classifiers) biomarkers have been developed. Despite previous biomarkers providing information on the pathophysiological mechanisms of CV risk in CKD beyond proteinuria and eGFR, only a minority have been adopted in clinical use. This mainly depends on heterogeneous results and lack of validation of biomarkers. The purpose of this review is to present an update on the already assessed biomarkers of CV risk in CKD and examine the strategies for a correct development of biomarkers in clinical practice. Development of both predictive and prognostic biomarkers is an important task for nephrologists. Predictive biomarkers are useful for designing novel clinical trials (enrichment design) and for better understanding of the variability in response to the current available treatments for CV risk. Prognostic biomarkers could help to improve risk stratification and anticipate diagnosis of CV disease, such as heart failure and coronary heart disease.

Introduction Cardiomyopaties like Cardiac Amyloidosis (CA), are an important cause of Heart Failure (HF). They can cause endocardial or transmural involvement. It is possible to characterize the kind of affectation thanks to different phenotypes identified by 2D speckle tracking echocardiography. Purpose: To study the pattern of myocardial involvement in patients (p) affected by CA and HF. Methods: Comparative study of 30 p with CA and HF, in NYHA class ≥II/IV, of which 16 had preseved left ventricle ejection fraction (pLVEF) and 14 had reduced LVEF (rLVEF), considering as cut point a LVEF > 50%. There was a control group (CG) of 16 healthy subjects. Twist, radial strain (RS), circunferential strain (CS) and longitudinal strain (LS) were determined using 2D speckle-tracking echocardiography, along with mitral annulus plane systolic excursion (MAPSE) and basal-apex distance (B-A). The following indexes were calculated: Twist (apical rotation + basal rotation, °); Torsion (twist/B-A, °/cm); Torsion Index (TorI: twist/MAPSE, °/cm), and Deformation Index (DefI:twist/LS,°). The last indexes are dynamic parameters that allow for a more realistic assessment of LV torsion, since they include longitudinal shortening measures such as MAPSE and LS, describing in a more complete and physiological way the global LV systolic movement. Results There were differences of age between the three gropus, being older the p with rLVEF and younger the ones in the CG (63,7 ± 2,8; 68,2 ± 11,5; y 73,9 ± 12,9 years respectively). LS and CS were lower in rLVEF group when compared with pLVEF group, as well as in pLVEF group compared with the CG. The p with pLVEF showed increased values of the dynamic torsion parameters (DefI and TorI), indicating a compensatory increase of LV twist that disappears in p with rLVEF. Twist and Torsion are significantly lower only in the rLVEF group (see table). Conclusions In both CA groups, LS and CS deterioration indicates endocardial and transmural involvement. The loss of compensation given by the increased LV twist, reflected by DefI and TorI, marks the transition to the deterioration of LVEF. Results Table LVEF (%) LS (%) CS (%) TWIST (°) Torsion (°/cm) TorI (°/cm) DefI (°/%) Control Group (n = 15) 68.2 ± 6.3 -20.6 ± 2.5 -22.7 ± 4.9 21.7 ± 6.1 2.7± 0.8 16.4 ± 4.7 -1.0 ± 0.3 CA pLVEF (n = 16) 60,6 ± 5.4* -11.7 ± 4.2* -17.2 ± 4.8* 19.8 ± 8.3 2.5± 1.1 27.7 ±13.5* -1.8 ± 0.9* CA rLVEF (n = 14) 37.2 ± 8.8** -8.7 ± 3.2** -13.0 ± 3.4** 8.3 ± 5.6** 1.0 ± 1.7** 13.4 ± 9.6** -1.0 ± 0.7** *:p value

BACKGROUND New echocardiographic phenotypes of heart failure (HF) are focused on myocardial systolic involvement of the left ventricle (LV), either endocardial and/or transmural. PURPOSE. To study the pattern of myocardial involvement in patients (p) with HF with preserved left ventricular ejection fraction (pLVEF) and cardiac amyloidosis (CA). METHODS. Comparative study of 16 p with CA and HF with pLVEF, considering as cut point LVEF > 50%, in NYHA class ≥ II / IV, and a control group of 16 healthy people. Longitudinal Strain (LS) and Circumferential Strain (CS) were calculated using 2D speckle-tracking echocardiography, along with Mitral Annulus Plane Systolic Excursion (MAPSE) and Base-Apex distance (B-A). Also, the following indexes were calculated: Twist (apical rotation + basal rotation, º); Classic Torsion (TorC): (twist/B-A, º/cm); Torsion Index (Tor.I): (twist/MAPSE, º/cm) and Deformation Index (Def.I): (twist/LS, º). We suggest the introduction of these dynamic torsion indexes as Tor.I and Def.I that include twist per unit of longitudinal systolic shortening of the LV instead of using TorC which is the normalisation of twist to the end-diastolic longitudinal diameter of the LV. RESULTS There were no differences of age between the groups (68.2 ± 11.5 vs 63.7 ± 2.8 years, p = 0.14). Global values of LS and CS were lower in p with CA indicating endocardial and transmural deterioration during systole, while TorC and Twist of the LV remained conserved in p with CA. However, there is an increase of dynamic torsion parameters such as Tor.I and Def.I that show an increased Twist per unit of longitudinal shortening of the LV in the CA group (Table). CONCLUSIONS In p with CA and HF with pLVEF, the impairment of LS and CS indicates endocardial and transmural systolic dysfunction. In these conditions, LVEF would be preserved at the expense of a greater dynamic torsion of the LV. Table LS (%) CS (%) Twist (º) TorC (º/cm) Tor.I (º/cm) Def.I (º/%) CA pLVEF (n = 16) -11.7 ± 4.2 17.2 ± 4.8 19.8 ± 8.3 2.5 ± 1.1 27.7 ± 13.5 -1.8 ± 0.9 Control Group (n = 15) -20.6 ± 2.5 22.7 ± 4.9 21.7 ± 6.1 2.7 ± 0.8 16.4 ± 4.7 -1.0 ± 0.3 p < 0.001 < 0.01 0.46 0.46 < 0.01 < 0.01 Dynamic Torsion Indexes and Classic Torion Parameters in pLVEF CA patients vs Control group.

Background: Dermal substitutes are currently largely used for the treatment of huge skin loss in patients in critical general health conditions, for the treatment of severe burns and to promote the healing process in chronic wounds. Aims: The authors performed a retrospective assessment of their experience with bioengineered skin to possibly identify the most appropriate clinical indication and management for each substitute. Materials and Methods: The study involved 109 patients with 127 skin defects repaired with dermal substitutes over a 9 years period, from 2007 to 2016. Hyalomatrix® was used in 63 defects, whereas Integra® and Nevelia® were used in 56 and 8 defects, respectively. Results: The statistical analysis failed to reveal a correlation between the choice of a specific dermal substitute and any possible clinical variable except in the soft-tissue defects of the scalp where Hyalomatrix® was electively used. Conclusions: In the authors’ experience, the scalp defects followed a radical excision of skin tumours that included the periosteum. Here, the preliminary cover with a hyaluronan three-dimensional scaffold constantly allowed for the regeneration of a derma-like layer with a rich vascular network fit for supporting a split-thickness skin graft. Nevertheless, the authors still prefer Integra® when the goal is a better cosmetic outcome and Hyalomatrix® when a faster wound healing is required, especially in the management of deep wounds where the priority is a fast obliteration with a newly formed tissue with a rich blood supply. However, these clinical indications still are anecdotally based.

Background:. The combination of surgery and postoperative radiotherapy allows for the most effective results with keloids. In this trial, surgery and intraoperative radiation therapy (IORT) technology were used—the hypothesis being that the earlier the application of postoperative radiotherapy, the better the wound healing evolution. Methods:. The study included 16 patients with 21 keloids. The keloids were radically excised and repaired with direct suture or local skin flaps. Collimated electron radiotherapy was applied within 45 minutes of surgery. The outcomes were assessed according to the modified Patient and Observer Scar Assessment Scale; the modified Vancouver Scar Scale; and the modified Common Terminology Criteria for Adverse Events v. 4.0 for skin and subcutaneous tissue disorders. Results:. Recurrences were observed in one out of 16 patients, and in two out of 21 keloids (9.5%). The modified Patient and Observer Scar Assessment Scale demonstrated a statistically significant improvement in pain, itching, color, stiffness, thickness, and irregularity after the treatment. The modified Patient and Observer Scar Assessment Scale displayed a statistically significant improvement in the scar vascularity, pigmentation, thickness, and pliability after the treatment. The modified Vancouver Scar Scale demonstrated a statistically significant improvement in 90.48% of the scars after the treatment. The modified Common Terminology Criteria for Adverse Events v. 4.0 for skin and subcutaneous tissue disorders demonstrated an improvement in erythema multiforme and skin pain across the whole sample, with a temporary hyperpigmentation in 19% of the scars after the treatment. Conclusion:. The combination of surgery and collimated electron radiotherapy with IORT technology demonstrated favorable results in 90.5% of the cases.

Introduction The objective of this study was to compare the methods of micro–computed tomography (micro-CT) and cross-sectioning followed by stereomicroscopy in assessing dentinal defects after instrumentation with different mechanized systems. Methods Forty mesial roots of mandibular molars were scanned and divided into 4 groups ( n = 10): Group R, Reciproc; Group PTN, ProTaper Next; Group WOG, WaveOne Gold; Group PDL, ProDesign Logic. After instrumentation, the roots were once again submitted to a micro-CT scan, and then sectioned at 3, 6, and 9 mm from the apex, and assessed for the presence of complete and incomplete dentinal defects under a stereomicroscope. The nonparametric Kruskal-Wallis, Friedman, and Wilcoxon tests were used in the statistical analysis. The study used a significance level of 5%. Results The total number of defects observed by cross-sectioning followed by stereomicroscopy was significantly higher than that observed by micro-CT, in all of the experimental groups ( P ≤ .05). All of the defects identified in the postoperative period were already present in the corresponding preoperative period. There was no significant difference among the instrumentation systems as to the median numbers of defects, for either cross-sectioning followed by stereomicroscopy or micro-CT, at all the root levels ( P > .05). In the micro-CT analysis, no significant difference was found between the median numbers of pre- and postinstrumentation defects, regardless of the instrumentation system ( P > .05). Conclusion None of the evaluated instrumentation systems led to the formation of new dentin defects. All of the defects identified in the stereomicroscopic analysis were already present before instrumentation, or were absent at both time points in the micro-CT analysis, indicating that the formation of new defects resulted from the sectioning procedure performed before stereomicroscopy and not from instrumentation.

The advent of deep-water oil exploration has increased concern for the impact of oil activities on marine environment, especially regarding disused or decommissioned facilities offshore. Before the Brent Spar incident, which galvanised international efforts to protect the environment, international and regional legal instruments on decommissioning of offshore oil installations was weak and ineffective in protecting the environment from the effect of disused facilities. This paper examined the efforts made by international and regional actors to remedy the lapses of the pre-Brent Spar legal instruments on decommissioning of offshore oil facilities, especially regarding the new provisions on environmental protection. The paper concluded that the supplementary legal instruments made post-Brent Spar have not radically transformed the legal regime on decommissioning of offshore oil facilities because contracting states still reserve the discretion to permit abandonment of disused facilities.

Objective: A study was established to objectively assess the effects of low-intensity electromagnetic and electric stimulation plus negative pressure on mature scars. Background: Radiofrequency plus negative pressure therapy demonstrated a favorable reorganization and regeneration of the collagen and elastic fibers and was proposed for the treatment of cellulitis and skin stretch marks. Methods: Twenty-six mature scars in 20 Caucasian patients (15 females and 5 males) were enrolled in the study. The treatments were carried out with a Class I, BF-type electromedical device equipped with a radiofrequency generator, an electric pulse generator, and a vacuum pump twice a week for 3 months. Corneometry, transepidermal water loss, elastometry, colorimetry, and three-dimensional skin surface pattern were objectively assessed with Multi Probe Adapter System MPA and PRIMOS pico. A subjective assessment was carried out with the VAS and PSAS scales. Each scar was compared before and after the treatment and with the skin in the corresponding healthy contralateral anatomical area at the same times. Results: Reduction of the scar surface wrinkling and overall scar flattening were demonstrated after the treatment. The scar slightly tended to approach the color and elasticity of healthy skin too. Conclusions: The combined local treatment of mature scars with low-intensity electromagnetic and electric stimulation in association with negative pressure might suggest a favorable synergic effect on the scar collagen and elastic fiber remodeling.

An important side effect of diagnostic contrast drugs is contrast-induced acute kidney injury (CI-AKI; a sudden decrease in renal function) occurring 48-72 hours after injection of a contrast drug that cannot be attributed to other causes. Its existence has recently been challenged, because of some retrospective studies in which the incidence of AKI was not different between subjects who received a contrast drug and those who did not, even using propensity score matching to prevent selection bias. For some authors, only patients with estimated glomerular filtration rate

This paper examined the phenomenon of hate speech and foul language on social media platforms in Nigeria, and assessed their moral and legal consequences in the society and to journalism practice. It used both quantitative and qualitative methodology to investigate the phenomenon. In the first place, the paper employed the survey research methodology to sample 384 respondents using questionnaire and focus group discussion as instruments for data collection. Findings from the research indicate that promoting hate speech and foul language on social media have moral and legal consequences in the society and to journalism practice. Findings also show that although, the respondents understand that hate speech and foul language attract legal consequences, they do not know what obligations are created by law against perpetrators of hate speech and foul language in Nigeria. The paper therefore, adopted the qualitative, doctrinal and analytical methodology to discuss the legal consequences and obligations created against perpetrators of hate speech and foul language in Nigeria. The paper concluded based on the findings that hate speech and foul language is prevalent on social media platforms in Nigeria and that there are adequate legal provisions to curb the phenomenon in Nigeria. It recommends among others things that the Nigerian government and NGOs should sponsor monitoring projects like the UMATI in Kenya to better understand the use of hate speech and that monitoring agencies set up under the legal regime should adopt mechanisms to identify and remove hate speech content on social media platforms in Nigeria.

Elimination or substitution of traditional lubricants results in the reduction of both operating costs and environmental impact associated with the use, filtration and disposal of metalworking fluids. However, traditional lubricooling are still widely used when machining “difficult to cut” materials, like Inconel 718, with the aim to increase tool life and obtain a surface with proper roughness. The need to move towards an eco-friendly machining pushed the authors to study the effects of alternative lubrication methods (Minimum Quantity Lubrication or Cooling and cryogenic one) on tool life, surface finish and machining costs, when turning Inconel 718. The material was machined with coated cemented carbide tools by a CNC lathe. Metal removing process was carried out under different cutting speeds while depth of cut and feed rate were kept constant. Economic analysis was also considered with the aim to evidence the most convenient condition. Minimum Quantity Cooling resulted in tool life and surface finish very similar to those obtained by conventional lubricooling, even if last one still remains the most convenient at economic level in the present case.

Objective: Previous studies have shown regenerative power of the skin with Comano (Trento, Italy) spring water and resident non-pathogenic microflora. This study investigated the action of bacterial lysates that were isolated from Comano spring water on in vitro culture of human skin fibroblasts. Methods: For this study, we selected the following four bacterial lysates: L1 (closest relative: Rudaea cellulosilytica), L2 (closest relative: Mesorhizobium erdmanii), L3 (closest relative: Herbiconiux ginsengi), and L4 (closest relative: Fictibacillus phosphorivorans). Human fibroblasts were cultured under Dulbecco’s modified Eagle’s medium (DMEM) with bacterial lysates added or DMEM (controls). Cell proliferation was evaluated by spectrophotometric absorbance analysis after the XTT-Microculture Tetrazolium Assay. Results: At 24 hours, cultures with L2, L3, and L4 showed a higher absorbance compared with controls. At 48 hours, cultures with L1, L2, and L3 showed slightly lower absorbance compared with controls, and culture with L4 showed a higher absorbance than in the other experimental conditions. At 72 hours, absorbance was lower in cultures with L1, L2, and L3 than in controls, and absorbance was higher in culture with L4 than in the other experimental conditions. Conclusions: Our study indicates a favorable action of Comano spring water microbiota on proliferation of human skin fibroblasts.

The aim of the present study was to assess the penetration capacity of two endodontic cements, Endosequence BC Sealer and AH Plus, in artificial lateral canals. Twenty-six two-rooted, maxillary first premolars were instrumented to size 40.06 using K3 files. In each root, six lateral canals of two diameters (0.06 and 0.10 mm) were created with a working length of 2, 4, and 6 mm. The specimens were randomly divided into two groups according to the endodontic cement to be used (Endosequence BC Sealer and AH Plus) and obturated by the single-cone technique. The specimens were imaged by digital periapical radiography and scores from 0 to 4 were attributed according to the degree of penetration by sealers into the lateral canals. Data were analyzed statistically by Kruskal-Wallis and Student-Newman-Keuls tests, and a significance level of p < 0.05 was adopted. No significant difference was observed between the two endodontic cements used to fill the simulated lateral canals (p > 0.05). The diameter of lateral canals only influenced the capacity of the Endosequence BC Sealer in filling the canals, and presented greater penetration in the lateral canals of diameter 0.10 mm (p < 0.05). We concluded that the bioceramic endodontic cement Endosequence BC Sealer presented similar ability as AH Plus to fill simulated lateral canals.

The present study aimed to evaluate the internal configuration of the maxillary molars of a population from the Northeast region of Brazil. Cone-beam computed tomography (CBCT) exams from 512 patients (1501 teeth) were evaluated regarding the anatomical configuration of the root canal system, according to Vertucci’s classification. The images were obtained using a Prexion 3D scanner operating at 90 kVp and 4 mA. The voxel size was 0.125 mm and the cut thickness was 1 mm. The images were then analyzed in the Prexion 3D Viewer software. The data were analyzed statistically by Pearson’s chi-square test, with 5% of significance. The first and second molars presented three roots in 99.14% and 87.27% of the cases, respectively. In relation to the number of canals, the first and second molars had a significantly higher frequency of three and four root canals respectively, presenting a higher prevalence of types I and II (p < 0.001). The second mesiobuccal canal (MB2) was observed in 48.21% and 22.72% of the first and second molars, respectively (p < 0.001). The identification of the MB2 canal was greater in young and adult patients (p < 0.001), presenting a higher prevalence in male patients (p < 0.001). The internal configuration of the MB root was influenced by gender and by age, presenting a higher prevalence of the MB2 in male patients younger than 50 years of age.

The University of Sao Paulo Resolution (USP-No 7465-11-01-2018) has established USP’s Environmental Policy. Its implementation in all campuses has been achieved through the development of the Environmental Master Plan (EMP), along with the university community. In 2017, USP Pirassununga and Ribeirao Preto, both located in Sao Paulo state, have given rise to the EMP initial ideas by organizing working groups (WG’s) covering several topics. All the WG’s are protected by the resolution and are also responsible for: describing the campuses specificities; defining the general goals; elaborating local indicators and procedures for future monitoring; developing governance and management models; monitoring, evaluating and reviewing the plan. USP Pirassununga campus is 2300 rural-orientated hectares, offering livestock, veterinary medicine and engineering degrees. On the other hand, in Ribeirao Preto there are 8 teaching unities that offer healthcare science, law, economics and financial science, natural and exact sciences, teaching training and music production degrees. There are around 200 people involved with the WG’s in Pirassununga and in Ribeirao Preto, and full professors, executive technician employees and students being the principal members. It is expected that the development of the EMP helps to improve USP sustainability issues.

Purpose To evaluate the first association specific to exudative age-related macular degeneration (AMD) located near the matrix metalloproteinase 9 (MMP9) gene. Design Genetic association study. Participants One thousand seven hundred twelve patients with AMD (672 nonexudative, 1040 exudative) of predominantly northern European descent seeking treatment at the University of Iowa Hospitals and Clinics. Methods We reanalyzed the International AMD Genetics Consortium (IAMDGC) data to validate the association of polymorphisms near MMP9 with exudative AMD and to identify additional associated single nucleotide polymorphisms (SNPs), especially MMP9 coding sequence SNPs. We genotyped a cohort of 1712 AMD patients from Iowa with 3 SNPs identified with our analysis of the IAMDGC cohort using commercially available real-time quantitative polymerase chain reaction (PCR) assays. Firth regression was used to measure the association between MMP9 SNP genotypes and exudative AMD in our cohort of patients from Iowa. In addition, we developed a PCR-based assay to genotype the Iowa cohort at a short tandem repeat polymorphism (STRP) at the MMP9 locus. Main Outcome Measures Odds ratios and P values for exudative compared with nonexudative AMD patients in the Iowa cohort for MMP9 SNPs (rs4810482, rs17576, and rs17577) and STRP. Results We identified 3 SNPs in the MMP9 locus (rs4810482, rs17576, and rs17577) that are highly associated with exudative AMD in patient cohorts of the IAMDGC. These MMP9 SNPs also are associated with exudative AMD in the cohort of 1712 AMD patients from Iowa (rs4810482: odds ratio [OR], 0.82; P = 0.010; rs17576: OR, 0.86; P = 0.046; and rs17577: OR, 0.80; P = 0.041). We also genotyped the cohort of AMD patients from Iowa at rs142450006, another MMP9 polymorphism that previously was associated with exudative AMD. We detected a 4bp STRP, (TTTC)n, at the rs142450006 locus that is highly polymorphic and associated significantly with exudative AMD (OR, 0.78; P = 0.016). Conclusions This study independently confirms and expands an association between the MMP9 locus and exudative AMD, further implicating a role for extracellular matrix abnormalities in choroidal neovascularization.

In 2011, the Central Bank of Nigeria (CBN) published regulations on non-interest financial institutions to regulate the emerging Islamic banking (I-banking) system in Nigeria. These regulations eli...

The term Acute Renal Failure (ARF) has been replaced by the term Acute Kidney Injury (AKI). AKI indicates an abrupt (within 24–48 h) decrease in Glomerular Filtraton Rate, due to renal damage, that causes fluid and metabolic waste retention and alteration of electrolyte and acid-base balance. The renal biomarkers of AKI are substances or processes that are indicators of normal or impaired function of the kidney. The most used renal biomarker is still serum creatinine that is inadequate for several reasons, one of which is its inability to differentiate between hemodynamic changes of renal function (“prerenal azotemia”) from intrinsic renal failure or obstructive nephropathy. Cystatin C is no better in this respect. After the description of the pathophysiology of “prerenal azotemia” and of Acute Kidney Injury (AKI) due to ischemia or nephrotoxicity, the renal biomarkers are listed and described: urinary NAG, urinary and serum KIM-1, serum and urinary NGAL, urinary IL-18, urinary L-FABP, serum Midkine, urinary IGFBP7 and TIMP2, urinary α-GST and π-GST, urinary ɣGT and AP, urinary β2M, urinary RBP, serum and urinary miRNA. All have been shown to appear much earlier than the rise of serum Creatinine. Some of them have been demonstrated to predict the clinical outcomes of AKI, such as the need for initiation of dialysis and mortality.

In patients with preexisting renal impairment, particularly those who are diabetic, the iodinated radiographic contrast media may cause contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI), that is, an acute renal failure (ARF), usually nonoliguric and asymptomatic, occurring 24 to 72 hours after their intravascular injection in the absence of an alternative aetiology. Radiographic contrast media have different osmolalities and viscosities. They have also a different nephrotoxicity. In order to prevent CIN, the least nephrotoxic contrast media should be chosen, at the lowest dosage possible. Other prevention measures should include discontinuation of potentially nephrotoxic drugs, adequate hydration with i.v. infusion of either normal saline or bicarbonate solution, and eventually use of antioxidants, such as N-acetylcysteine, and statins.

Purpose Primary open-angle glaucoma (POAG) is a major cause of blindness and visual disability. Several genetic risk factors for POAG and optic nerve features have been identified. We measured the relative risk for glaucoma that these factors contribute to participants in the Ocular Hypertension Treatment Study (OHTS). Design Comparative series. Participants One thousand fifty-seven of 1636 participants (65%) of the OHTS were enrolled in this genetics ancillary study. Methods Samples of DNA were available from 1057 OHTS participants. Of these, 209 developed POAG (cases) and 848 did not develop glaucoma (controls) between 1994 and 2009. The frequencies of 13 risk alleles previously associated with POAG or with optic disc features in other cohorts were compared between POAG cases and controls in the OHTS cohort using analyses of variance. The 2 largest subgroups, non-Hispanic whites (n = 752; 70.7%) and blacks (n = 249, 23.7%), also were analyzed separately. The probability of glaucoma developing over the course of the OHTS was compared between participants stratified for transmembrane and coiled-coil domains 1 ( TMCO1 ) risk alleles using Kaplan-Meier and Cox proportional hazards analyses. Main Outcome Measures Association of POAG with known genetic factors. Results No association was detected between the known POAG risk alleles when the OHTS cohort was examined as a whole. However, in the subgroup of non-Hispanic whites, allele frequencies at the TMCO1 locus were statistically different between cases and controls ( P = 0.00028). By 13 years, non-Hispanic white participants with TMCO1 risk alleles had a 12% higher cumulative frequency of glaucoma developing than participants with no TMCO1 risk alleles. Moreover, the Cox proportional hazard analysis demonstrated that TMCO1 alleles increased relative risk comparable with that of some previously analyzed clinical measures (i.e., intraocular pressure). Conclusions The size of the OHTS cohort and its composition of 2 large racial subgroups may limit its power to detect some glaucoma risk factors. However, TMCO1 genotype was found to increase the risk of glaucoma developing among non-Hispanic whites, the largest racial subgroup in the OHTS cohort, at a magnitude similar to clinical predictors of disease that long have been associated with glaucoma.

The maintenance of internal and external security of the state is essentially the primary duty of the government. In Nigeria, this has become imperative in the face of the myriad of threats to her national security from within and outside. Nigeria has been bedeviled by the problem of insecurity caused by armed robbery, political violence, ethno-religious conflicts, Fulani herdsmen, Boko Haram insurgents and the Niger Delta insurgency. For a country trying to nurture her evolving democracy, security threat in whatever form is antithetic to sustainable democracy. This paper therefore, examines the elements of national security, which include but not limited to military, political, economic, and environmental security. It concludes that the myriad of security threats facing the country requires more than military force to resolve in order to achieve true national security. The paper recommended several measures to be put in place by the government to deemphasize its absolute reliance on the military for national security; ranging from the use of other elements of national power, such as diplomacy, negotiation and law enforcement, social and economic equity to environmental justice.

Objective : The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. Methods : We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. Results : Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. Conclusions : We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches. Evidence Level: IV, Cadaveric Study.

Chronic kidney disease is a growing public health problem, as its prevalence and incidence have almost doubled over the last three decades. Chronic kidney disease is defined as the presence of an estimated glomerular filtration rate < 60 ml/min/1.73 m² and/or proteinuria ≥ 0.150 g/24 h. It has been demonstrated that both proteinuria and reduction in estimated glomerular filtration rate can predict the development of fatal and non-fatal cardiovascular events, regardless of traditional cardiovascular risk factors, namely blood pressure, smoking habit, cholesterol, age, gender. This relationship is found in the general population, high-risk cohorts and in patients referred to Nephrologists (tertiary care). The accuracy by which proteinuria or estimated glomerular filtration rate can predict these events, exceeds that obtained by the combination of all the other traditional risk factors. These important findings have led to chronic kidney disease being considered as a cardiovascular risk equivalent. Although this needs further investigation, a great effort has been made to reduce the cardiovascular risk in chronic kidney disease patients. Indeed, many clinical trials have been carried-out testing the effect of antihypertensive, proteinuria-lowering, lipid-lowering and hypoglycemic agents on cardiovascular risk protection. All these trials reduced, but did not eliminate, the overall cardiovascular risk. Future studies should be undertaken to identify high cardiovascular risk patients and novel therapeutic targets for cardiovascular protection in chronic kidney disease patients.

OBJECTIVE: Supernumerary teeth (ST) are associated with many complications that include tooth impaction, ectopic eruption, and abnormal development of root. The usual treatment is the extraction, although repositioning in the dental arch may sometimes be an alternative. The present study reports the treatment of a case of multiple supernumerary teeth in a non-syndromic patient.CASE DESCRIPTION: A 16-year-old male patient presented two ST in each side of the jaw, detected by panoramic radiography. Syndromes or systemic diseases were not revealed by the anamnesis/ general health history. Cone Beam Computed Tomography (CBCT) showed that the teeth were positioned in the lingual region between the inferior premolars at both right and left sides. Surgical therapy was the treatment of choice, in order to avoid possible eruption.CONCLUSION: An early and accurate diagnosis is extremely important for treatment decision and success, thus avoiding future complications often related to ST. OBJECTIVE: Supernumerary teeth (ST) are associated with many complications that include tooth impaction, ectopic eruption, and abnormal development of root. The usual treatment is the extraction, although repositioning in the dental arch may sometimes be an alternative. The present study reports the treatment of a case of multiple supernumerary teeth in a non-syndromic patient.CASE DESCRIPTION: A 16-year-old male patient presented two ST in each side of the jaw, detected by panoramic radiography. Syndromes or systemic diseases were not revealed by the anamnesis/ general health history. Cone Beam Computed Tomography (CBCT) showed that the teeth were positioned in the lingual region between the inferior premolars at both right and left sides. Surgical therapy was the treatment of choice, in order to avoid possible eruption.CONCLUSION: An early and accurate diagnosis is extremely important for treatment decision and success, thus avoiding future complications often related to ST. *** Dentes supranumerários múltiplos em paciente não sindrômico: caso clínico e revisão de literatura ***OBJETIVO: Os dentes supranumerários estão associados com muitas complicações que inclui a impactação de dentes, erupção ectópica, e desenvolvimento anormal da raiz. Normalmente, o tratamento escolhido é a extração dental, embora o reposicionamento na arcada dentária pode ser uma alternativa. O presente estudo reporta o tratamento de um caso de dentes supranumerários múltiplos em um paciente não sindrômico. RELATO DO CASO: Paciente do sexo masculino de 16 anos de idade apresentou 2 dentes extranumerários em cada lado da mandibular, detectado pela radiografia panorâmica. Doenças sistêmicas e síndromes não foram reveladas durante a anamnese do paciente. A tomografia computadorizada Cone Beam mostrou que os dentes estavam posicionados na região lingual entre os pré-molares de ambos os lados direto e esquerdo. A terapia cirúrgica foi o tratamento de escolha, a fim de evitar possível erupção.CONCLUSÃO: Um diagnóstico precoce e preciso é extremamente importante para a decisão e o sucesso do tratamento, evitando assim futuras complicações frequentemente relacionadas ao supranumerário.Palavras-chave: Dentes supranumerários, Anomalia dental, Mal oclusão, Hyperdontia.

There is a growing interest in the electrical energy storage system, due to the high penetration of the energy produced by renewable sources, the possibility of leveling the absorption peak of the electric network (peak shaving) and the advantage of separating the production phase from the exertion phase (time shift). Compressed air energy storage systems (CAES) are one of the most promising technologies of this field, because they are characterized by a high reliability, low environmental impact and a remarkable energy density. The main disadvantage of big systems is that they depend on geological formations which are necessary to the storage. The micro-CAES system, with a rigid storage vessel, guarantees a high portability of the system and a higher adaptability even with distributed or stand-alone energy productions. This article carries out a thermodynamical and energy analysis of the micro-CAES system, a result of the mathematical model created in a Matlab/Simulink ® environment. New ideas will be discussed, as the one concerning the quasi-isothermal compression/expansion, through the exertion of a biphasic mixture, that will increase the total system efficiency and enable a combined production of electric, thermal and refrigeration energies. This is something promising for the development of an experimental device.