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Research Question Did a 15-min patrol delivery over 1 day reduce serious violent crime in large hot spots (mean size = 2 km × 2 km), without displacing such crimes to nearby areas? Data We tracked daily official crime reports in a sample of 21 high-crime Bedfordshire (UK) Lower-layer Super Output areas (LSOAs). We measured time spent by two-person police foot patrols in those areas with daily GPS data from handheld devices given to officers working on overtime. We also counted proactively initiated arrests. Methods We used a crossover randomised controlled trial on the 21 “hot spot” LSOAs, each of which was randomly assigned daily to be either in a treatment condition of 15-min of patrol (as one of seven each day) or a control condition of no patrol (as one of 14 each day) for each of 90 days. We used an intention-to-treat framework to analyse the impact of patrols on the outcome measures overall, on consecutive days of assignment to the same condition, and in 100-m ‘buffer’ zones around each hot spot. Findings We found that on treatment days the hot spots had 44% lower Cambridge crime harm index scores from serious violence than on control days, as well as 40% fewer incidents across all public crimes against personal victims. Statistically significant differences in lower prevalence, counts and harm of both non-domestic violent crime and robbery and other non-domestic crimes against personal victims were also found. We found no evidence of either displacement of serious crime into a 100-m buffer zone, nor any evidence of residual deterrence on no-patrol days following patrol days. We did find evidence of a cumulative effect: the largest differences in crime harm on control days were found in treatment days that came after 3 days of consecutive patrol in the same LSOA. Conclusions Even minimal amounts of foot patrol can prevent serious violent crime across a large area, and repeated patrols over several days help even more. Our findings suggest that, to reduce both violent and other forms of crime, uniformed officers need to patrol hot spots for short amounts of times on consecutive days.

Background: the general population is aging across the world. Therefore, even surgical interventions in the elderly—in particular those involving emergency surgical admissions—are becoming more frequent. The elderly population is often frail (in multiple physiological systems, this is often defined as age-related cumulative decline). This study involved a 2-year follow-up evaluation of frail elderly patients treated with urgent surgical intervention at Santa Maria Regina della Misericordia Hospital, General Surgery Department, in Adria (Italy). Method: a prospective, single-center, 2-year follow-up study of 120 patients &gt, 65 years old, treated at our department for surgical abdominal emergencies. We considered co-morbidities (ASA—American Society of Anesthesiologists Physical Status Classification System—score), type of surgery (laparoscopy, laparotomy or converted), frailty score, mortality, and complications at 30 days and at 2 years. Conclusions: 70 (58.4%) patients had laparoscopy, 49 (40.8) had laparotomy, and in 1 (0.8%) case, surgery was converted from laparoscopy to laparotomy. Mortality strictly depends on the type of surgery (laparotomy vs. laparoscopy), complications during recovery, and a lower Fried frailty criteria score, on average. The long-term follow-up can be a useful tool to highlight a safer surgical approach, such as laparoscopy, in frail elderly patients. We consider the laparoscopic approach feasible in emergency situations, with similar or better outcomes than laparotomy, especially in frail elderly patients.

An integrated model, based on a One Health approach, was implemented to estimate the epidemiological and economic outcomes of cystic echinococcosis (CE) in Veneto region, an hypo-endemic area of Northern Italy, and the costs for its prevention. Data and information needed to populate the model were retrieved from published literature, official statistics, expert opinions, or actively searched through data mining (i.e., Hospital and slaughterhouse data), when fundamental data were not available. Human-health and animal-health costs, both public and private, were considered. The overall impact of CE in the study area was estimated in an yearly cost of about 0.5 million €, due to an average of 19.5 human hospitalized cases and about 200 infected animals among cattle and sheep, per year. The human:animal costs ratio was about 8:1. Most of the infected animals were autochthonous, while the identification of an autochthonous source of the infection for the human cases was extremely difficult, and unlikely in most cases. No specific action resulted to be in place for human surveillance, while veterinary surveillance accounted for a yearly cost of about 22,000 €. Sheepherders were found to pay privately an overall amount of around 2000 € for the preventive treatment of their dogs every year, but the applied protocol proved to be sub-optimal. The source of most of the human cases was likely external to the study area, and their economic impact accounts for a cost that is far exceeding that of surveillance and preventive actions in place in the veterinary sector. Although autochthonous human cases appeared to be very rare, the strengthening of preventive actions and surveillance systems can reduce the risk of their increment., Highlights • The study integrated epidemiology and economic aspects in a One Health perspective. • The research estimates in detail the overall impact of CE in a hypo-endemic region in Italy. • The study provided data for evidence-based actions to control CE in the study area. • The investigated case study represents a reproducible model for zoonotic diseases evaluation.

The SARS-CoV2 pandemic forced an abrupt interruption of social contacts and interpersonal affective relationships all over the world, according to national directives. Many considerable inconveniences occurred with important repercussions also on the emotional state of people and their pets. We carried out a national survey to evaluate the human-dog relationship in a social isolation context using an adapted version of Monash Dog Owner Relationship Scale, the perception of the dogs’ discomfort by their human owners, and the resilience of the dog through the quantification of symptoms, in time of the first lockdown of the COVID-19 pandemic. The results highlighted that the human-dog interaction was similar during quarantine, however, there was lower owner’s perception of a dog’s cost during the quarantine than before it.

This study prospectively assessed the 6-month prevalence of self-reported and psychophysically measured olfactory dysfunction in subjects with mild-to-moderate COVID-19. Self-reported smell or taste impairment was prospectively evaluated by SNOT-22 at diagnosis, 4-week, 8-week, and 6-month. At 6 months from the diagnosis, psychophysical evaluation of olfactory function was also performed using the 34-item culturally adapted University of Pennsylvania Smell Identification Test (CA-UPSIT). 145 completed both the 6-month subjective and psychophysical olfactory evaluation. According to CA-UPSIT, 87 subjects (60.0%) exhibited some smell dysfunction, with 10 patients being anosmic (6.9%) and seven being severely microsmic (4.8%). At the time CA-UPSIT was administered, a weak correlation was observed between the self-reported alteration of the sense of smell or taste and olfactory test scores (Spearman’s r = −0.26). Among 112 patients who self-reported normal sense of smell at last follow-up, CA-UPSIT revealed normal smell in 46 (41.1%), mild microsmia in 46 (41.1%), moderate microsmia in 11 (9.8%), severe microsmia in 3 (2.3%), and anosmia in 6 (5.4%) patients; however, of those patients self-reporting normal smell but who were found to have hypofunction on testing, 62 out of 66 had a self-reported reduction in sense of smell or taste at an earlier time point. Despite most patients report a subjectively normal sense of smell, we observed a high percentage of persistent smell dysfunction at 6 months from the diagnosis of syndrome coronavirus 2 (SARS-CoV-2) infection, with 11.7% of patients being anosmic or severely microsmic. These data highlight a significant long-term rate of smell alteration in patients with previous SARS-COV-2 infection.

The coronavirus disease 2019 (COVID-19) caused by the Severe-Acute-Respiratory-Syndrome Coronavirus 2 (SARS-CoV-2) has widely spread throughout the world since December 2019 . One of the main symptoms of COVID-19 is alteration of smell or taste, suggesting that high viral load can be found in the nose . CDC guidelines have recommended that diagnostic swabs should be performed in specific areas of the respiratory tract such as the nasopharynx, oropharynx, nasal turbinate, and anterior nares. Nasal and nasopharyngeal swabbing requires the introduction of a foreign body into a delicate area that can result in harm to the patient. In this paper we present the complications encountered in a series of health workers who underwent oro/nasopharyngeal swab for detection of SARS-CoV-2.

Two experiments evaluated the effects of gonadotropin releasing hormone (GnRH) treatment on fertility of suckled Nelore beef cows treated with an estradiol/progesterone (P4)-based protocol for timed artificial insemination (TAI). Experiment 1 was designed to determine the effect of GnRH administered 34 h after P4 insert removal (GnRH34) on time of ovulation. Suckled cows (n = 34) were treated with 2 mg estradiol benzoate (EB) and an intravaginal insert containing 1.9 g of P4. Eight days later, P4 inserts were removed, and all cows received 150 μg of d-cloprostenol (prostaglandin F2 alpha analogue), 300 IU of eCG, and 1 mg of estradiol cypionate (ECP). On Day 9 (05:00 p.m.), cows were randomly distributed, according to the diameter of the pre-ovulatory follicle, in two treatments: 1) GnRH (n = 17) cows that received 10.5 μg of buserelin acetate, or 2) no further treatment (control, n = 17). Cows treated with GnRH 34 h after P4 insert removal ovulated earlier (P = 0.02) than control cows (66 ± 0.0 and 77.2 ± 4.3 h). Experiment 2 was designed to determine the effect of GnRH34 on the fertility of suckled beef cows. Nelore cows (n = 506) were treated as Experiment 1. On Day 8, cows were painted in the sacrocaudal region to identify cows that displayed estrus. On Day 9 (05:00 p.m.), cows were randomized to receive same treatment as Experiment 1, control (n = 252), or GnRH (n = 254). All cows were TAI 48 h after P4 insert removal. At TAI, estrus was evaluated, and deemed to have occurred in cows without a tail-head chalk mark (75% paint loss). Cows treated with GnRH 34 h after P4 insert removal had greater (P = 0.01) pregnancy per AI (P/AI) than cows that only received ECP (63.0% and 50.4%). No difference (P = 0.5) was observed in the proportion of cows that displayed estrus between treatments. Furthermore, cows that displayed estrus had greater (P 0.01) P/AI than cows that did not. Treatment with GnRH, given at 34 h after P4 insert removal, increased (P 0.05) P/AI in cows that did not show estrus at TAI. In summary, treatment with GnRH 34 h after P4 insert removal was associated with earlier ovulation and resulted in greater P/AI in suckled Nelore cows treated with an estradiol/P4-based protocol for TAI.

This study prospectively assessed the long-term prevalence of self-reported and psychophysically measured olfactory dysfunction in subjects with mild-to-moderate COVID-19. Self-reported smell or taste impairment was prospectively evaluated by SNOT-22 at diagnosis, 4-week, 8-week, and 6-month. At 6 months from the diagnosis, psychophysical evaluation of olfactory function was also performed using the 34-item culturally adapted University of Pennsylvania Smell Identification Test (CA-UPSIT). 145 completed both the 6-month subjective and psychophysical olfactory evaluation. According to CA-UPSIT, 87 subjects (60.0%) exhibited some smell dysfunction, with 54 (37.2) being mildly microsmic, 16 (11.0%) moderately microsmic, 7 (4.8%) severely microsmic, and 10 patients (6.9%) being anosmic. At the time CA-UPSIT was administered, a weak correlation was observed between the self-reported alteration of sense of smell or taste and olfactory test scores (Spearman’s r=-0.26). Among 112 patients who self-reported normal sense of smell at last follow-up, CA-UPSIT revealed normal smell in 46 (41.1%), mild microsmia in 46 (41.1%), moderate microsmia in 11 (9.8%), severe microsmia in 3 (2.3%), and anosmia in 6 (5.4%) patients; however, of those patients self-reporting normal smell but who were found to have hypofunction on testing, 62 out of 66 had self-reported reduction in sense of smell or taste at an earlier time point. Despite most patients report a subjectively normal sense of smell, we observed a high percentage of persistent smell dysfunction at 6 months from the diagnosis of SARS-CoV-2 infection, with 11.7% of patients being anosmic or severely microsmic. These data highlight a significant long-term rate of smell alteration in patients with previous SARS-CoV-2 infection.

Nosemosis is an important disease that affects honey bees (Apis mellifera Lineu), caused by obligate intracellular parasites, Nosema apis and/or Nosema ceranae. Since the initial detection of N. ceranae in A. mellifera coincided with recent large-scale losses of bee colonies worldwide, the impacts of this parasite under field conditions are of great interest. Here we test two hypotheses, the first one, whether the climatic variables (temperature, air humidity and precipitation) influence the intensity of infection of the microsporidium Nosema spp. in Africanized honey bees (Apis mellifera), and the second, whether the local of hive installation (outdoor or roofed) influences the intensity of infection of these spores in Africanized honey bees. Between August 2013 and August 2016, samples of Africanized bees were collected weekly from 20 colonies, of which ten were located in an open area (outdoor apiary) and ten under a roof on a concrete floor (roofed apiary). N. ceranae was the only species present. The type of apiary did not influence (p > 0.05) the number of spores of N. ceranae in Africanized bees. However, the infection intensities of the roofed apiary colonies were lower in the autumn. Regarding the meteorological parameters, there was a negative correlation between the winter infection intensities and the minimum temperature in the roofed apiary and the humidity in the outdoor apiary. The highest infection intensities occurred in both apiaries in the spring and summer, which may be related to higher pollen production. On average, the infection intensity was 16.19 ± 15.81 x 105, ranging from zero to 100.5 x105, and there were no records of collapse during the three years.

This work aims to encapsulate anthocyanins and phenolic compounds extracted from a native Brazilian fruit peel - jabuticaba (Plinia cauliflora (Mart.) Kausel) and propolis from Tubuna (Scaptotrigona bipunctata) stingless bees, with great potential benefits for human health. The alginate encapsulation was conducted by the ionotropic gelation through the dripping into the CaCl2 solution. Both raw extracts were characterized by TPC - total phenolic content (Folin-Ciocalteu), AA -antioxidant activity (DPPH and ABTS assays), and TMAC - total monomeric anthocyanin concentration (pH differential method); as well as their resultant mixture (2:1 jabuticaba/propolis). The obtained beads presented highly efficient encapsulation of total polyphenols (~98%) and monomeric anthocyanins (~89%), with spherical morphology and smooth surface obtaining a mean diameter between 200 and 250 μm. In vitro release study showed that JPE/alginate beads were completely disintegrated at pH 7.4 (intestinal pH), but they were resistant to gastric pH (1.2) presenting a slow release of about 40% in 240 min. This is the first report that encapsulates the mixture of jabuticaba and propolis extracts and may contribute to the utilization of a great source of bioactive compounds besides the potential pigment of anthocyanins, an alternative to natural and healthy food/beverage colorants.

Introduction: Anal fistula is an abnormal pathway that connects the anorectal tract to the perianal skin. The Park’s classification describes four different types of anal fistulas depending on their links with the sphincter apparatus. In this paper, we report an interesting case of post-traumatic complex trans-sphincteric fistula treated with VAAFT procedure. Case Presentation: A 60-year-old-male patient, from an accidental fall, developed a gluteal abscess with a high trans-sphincteric anal fistula and a secondary tract leading to a large second abscess located in the right ischiorectal fossa. An abscess incision was done, and a draining seton was placed in another Institution. The patient came to our Hospital and underwent surgery using Video Assisted Anal Fistula Treatment (VAAFT) procedure. Conclusions: VAAFT is an effective and safe procedure for complex anal fistula, even when they have a post-traumatic origin.

Metabolic syndrome (MetS) is a condition characterized by a constellation of reversible major risk factors for cardiovascular disease (CVD) and type 2 diabetes (T2DM). While it has been widely demonstrated that weight reduction by 5–10% decreases CVD and T2DM risk factors, including atherogenic dyslipidemia, on the other hand, its effects on comprehensive serum cytokine profile and endotoxemia are less investigated. Furthermore, the impact of weight loss on these parameters was studied especially in subjects with morbid obesity, often after bariatric surgery; while the studies on the effects of a physiological weight reduction with a balanced hypocaloric diet in overweight and moderately obese subjects showed contradictory results.The aim of this pilot study was to investigate in overweight and obese men with MetS the effects of caloric restriction on the MetS-associated risk factors, chemical composition of lipoproteins and serum concentration of a wide spectrum of inflammation markers. In addition, the second purpose of this work was to study the possible correlation between lipoprotein chemical composition and these inflammation markers.Eighteen adult Caucasian males (25 kg/m2 < BMI < 35 kg/m2) with MetS losing at least 5% of their initial weight after six months of a Mediterranean-style balanced hypo-caloric diet were included in the study. Lipoproteins were isolated from plasma by ultracentrifugation in a discontinuous KBr gradient. Lipoprotein concentrations of proteins, cholesterol, phospholipids, and triacylglycerols were determined by colorimetric assays. Peripheral cytokine levels (IL-2, IL-6, IL-7, IL-8, IL-10, IL-12, IL-17, GM-CSF, MCP-1, MIP-1b, IL1-b, IL-4, IL-5, IL-13, G-CSF, INF-g, TNF-a) were determined by Bioplex multiplex immunoassay. Endotoxemia was measured by Limulus Amebocyte lysate assay. The effects of weight-loss were analysed by Wilcoxon's test, the correlations between covariates by Spearman's test (significance: p-value ≤ 0.05).After weight loss, we observed an improvement of MetS-associated risk factors and changes in lipoproteins composition. In particular, together with a reduction of triglyceridemia, we detected a massive transfer of triacylglycerols from HDLs toward LDLs. Furthermore, a significant decrease of IL-6 (0.9 ± 0.7 vs 0.5 ± 0.6), TNF-α (0.7 ± 0.3 vs 0.3 ± 0.18), IL-8 (1.6 ± 0.7 vs 1.3 ± 0.3) and MIP-1β (19.2 ± 1.5 vs 18.5 ± 1.5) was observed. Finally, peripheral levels of TNF-α and IL-8 were directly correlated with all lipid species of VLDL, whereas the concentration of MIP-1β and endotoxin with HDL lipids.Weight loss improved cardio-metabolic risk factors and decreased inflammatory state by reduction of cytokine levels. The relationships between lipoprotein composition and serum inflammation markers deserve to be deepened by studying broader populations.

Due to their ecological and economic importance, honey bees have attracted much scientific attention, which has intensified due to the recent population decline of these insects in the several parts of the world. Among the factors related to these patterns, infection by pathogens are the most relevant, mainly because of the easy dissemination of these microorganisms. Although no zoonotic diseases are associated with these insects, the presence of infectious agents in bee products should still be considered because they play a role as disease dispersers, increasing the risk to animal health. Because of the possibility of dispersion of pathogens via bee products, this work aimed to identify the presence of spores of the pathogens Paenibacillus larvae, Ascosphaera apis and Nosema spp. in samples of honey, pollen and royal jelly that are registered with Brazil's Federal Inspection Service (S.I.F.) and commercially available in the state of São Paulo. Of the 41 samples of bee products analyzed, only one showed no contamination by any of these pathogens. N. ceranae and P. larvae had the highest prevalence considering all the samples analyzed (present in 87.80% and 85.37% of the total, respectively), with N. apis present in 26.83% and A. apis present in 73.17% of the samples. These results provide support for the formulation of government regulations for sanitary control of exotic diseases by preventing dispersion of pathogens, including through illegal importation, since local and international trade and the transfer of colonies between regions play important roles in the dispersion of these microorganisms. Keywords: Apis mellifera, Honey, Multiplex PCR, Pollen, Royal jelly

The aim of this study was to evaluate if prostaglandin F2α (PGF) can be used to induce ovulation in a GnRHprogesterone based protocol. In Experiment 1 crossbred dairy cows (n = 32) were synchronized with a progesterone-GnRH based protocol for seven days, where the luteolytic dose of 150 μg PGF was given 24 h prior progesterone device removal (CIDR). On Day 8 cows were separated into two groups to receive: 1) 2 mL of Saline (Control Group, n = 15) or 2) 150 μg of PGF (PGF Group, n = 17). Ovulation rate was higher in the PGF than Control group (100% vs 53.3%, P = 0.001, Odds ratio = 30.88). The percentage of cows that ovulated synchronously tended to be higher in the PGF than Control group (P = 0.1, Odds ratio = 9.6). Experiment 2 was performed in a cross-over (3 × 3) design. Crossbred dairy cows (n = 25) received a CIDR for seven days and GnRH on Day 0. Seven days later 150 μg of PGF was given and the progesterone device was removed, and 24 h later cows were distributed into three groups to receive: 1) 2 mL of Saline (Control Group, n = 25), 2) 150 μg of PGF (PGF Group, n = 25) or 3) 1 mg of ECP (ECP Group, n = 23). Diameter of ovulatory follicle was larger in the PGF and Control than ECP Group (P = 0.002, Effect size > 4.0). Synchronized ovulation rate (between 72 and 96 h after CIDR removal) tended to be higher in PGF group in Control group (P = 0.1, Odds ratio = 0.35). Results suggest that PGF is equally efficient to ECP to induce synchronized ovulation in dairy cows subjected to progesterone-GnRH based protocols. Made available in DSpace on 2018-02-20T00:32:35Z (GMT). No. of bitstreams: 1 UseofCastro.pdf: 279259 bytes, checksum: 5f7ebd354e5a9e4a97a2ea76a2d5e47d (MD5) Previous issue date: 2018-02-19

The aim of this study was to compare the use of artificial insemination in time blocks (Artificial Insemination Blocks, AIB) using an 8 and 9 d estradiol-progesterone based protocol. In this experiment, lactating Nelore cows (n = 253) were subjected to two estradiol-progesterone based TAI protocols. On the morning of Day 10 (8d group, n = 124) or Day 11 (9d group, n = 129), cows were examined by ultrasonography to evaluate the diameter of the preovulatory follicle and were inseminated once at one of the following time points, according to the diameter of the pre-ovulatory follicle (POF): Block 0 (POF ≥ 15 mm, TAI 0 h after conventional TAI), Block 1 (POF 13.0–14.9 mm, TAI 6 h later), Block 2 (POF 10.1–12.9 mm, TAI 24 h later), and Block 3 (POF ≤ 10.0 mm, TAI 30 h later). The pregnancy per AI (P/AI) did not differ between 8d and 9d groups (P > 0.05). Considering only multiparous cows, however, P/AI tended to be greater in the 8d (64.1%) than in the 9d group (49.3%; P = 0.08). Cows from the 9d group tended to have a larger POF than cows from the 8d group (P = 0.07). In conclusion, these results provide evidence that there is no difference between 8d or 9d protocols when using the AIB technique. Use of the 8d estradiol-progesterone based protocol, however, tended to increase pregnancy in multiparous cows.

The objectives of this study were to: 1) evaluate the relationship of the angle formed between the left and right sides of the rump with body condition score (BCS) in cattle; and 2) develop an objective tool to select cows for timed artificial insemination (TAI) based on their BCS. In Experiment 1, 801 lactating Nelore cows, 3–12 years old and weighing 400–625 kg were enrolled. All females were evaluated according to BCS (scale 1–5). In addition, the angle formed between both sides of the rump was measured in all cows with a goniometer. The relationship between BCS and the rump angle was analyzed by linear regression. There was a positive relationship between BCS and rump angle (P 2 =0.67. The aim of Experiment 2 was to evaluate BCS in a simple, direct and objective way using rump angle and related BCS to TAI performance. A device was developed called Vetscore ® to determine BCS according to rump angle. Using the Vetscore, cows were classified into three different categories of BCS using a color-based method: red, BCS 4.5. A total of 429 Nelore suckling cows, 4–8 years old, were subjected to a TAI protocol based on estradiol benzoate, exogenous progesterone, prostaglandin F2α, equine chorionic gonadotropin and estradiol cypionate. At Day 0, all cows were evaluated with the Vetscore ® and classified according to the device's BCS color scale. Pregnancy diagnosis was performed by ultrasonography 30 d after TAI. Pregnancy per AI (P/AI) was analyzed using the chi-square test. A good level of agreement was observed between Vetscore's scale and visual BCS (82.9%). Cows classified as “green” had higher P/AI than cows classified as “red” and “yellow“ (60.4%, 168 of 278; 42.4%, 61 of 144; and 28.6%, 2 of 7; respectively; P ® is an efficient and low-cost methodology for the assessment of BCS and, indirectly, nutritional status of beef cows. Finally, cows classified as adequate according to Vetscore ® color scale had higher P/AI at 30 d compared with those considered inadequate.

Immunosuppression consists in a risk factor for opportunistic infections or diseases, many of them with oral manifestations. A 37-year-old man who had undergone kidney transplant 4 years ago was referred to our service for evaluation of bilateral palate ulcers on suspicion of lymphoproliferative disease. Clinically, 2 shallow, symmetric, and painful ulcers in hard palate mucosa with gingival involvement were observed. The periodontal examination did not show any alteration; however, the leukocyte counts revealed neutropenia, suggesting association with the injury. Incisional biopsy was performed under antibiotic coverage, and the patient was later hospitalized because of worsening neutropenia and the oral ulceration. Histopathologic examination was compatible with neutropenic ulcer, and it presented spontaneous improvement concomitant to elevation of the number of neutrophils. The patient remains under follow-up with progressive clinical improvement. Therefore, neutropenia contributes to the development of nonspecific oral lesions, and the association between clinical and hematologic examination is important for appropriate diagnosis and treatment.

Negli ultimi vent’anni si sono diffuse e perfezionate nella pratica clinica specifiche tecnologie per il trattamento delle ferite di difficile guarigione, come la terapia a pressione negativa (negative pressure wound therapy, NPWT). Tale terapia consente l’accelerazione dei tempi di guarigione di ferite inveterate e una sicura riduzione dei tempi di degenza nei pazienti ricoverati. All’interno di un reparto clinico per acuti risulta tuttavia indispensabile definire le corrette indicazioni ed il modello organizzativo che consenta di ottimizzare le risorse, ridurre gli sprechi e dare risposte tempestive ed efficaci alle persone che possono beneficiare di questo trattamento. È stata condotta un’analisi quantitativa sull’uso della metodica NPWT nei reparti acuti dell’Ospedale Beata Vergine di Mendrisio nell’anno 2017, base per la realizzazione di un audit clinico; i dati ottenuti sono stati rapportati alle attuali evidenze scientifiche sul tema per evidenziare allineamenti e/o scostamenti nella pratica clinica quotidiana. L’audit è uno strumento di Governo Clinico; utilizzare questa metodologia vuol dire favorire una migliore conoscenza da parte degli operatori sanitari delle attività cliniche e gestionali. È, infatti, un processo di revisione strutturata fra pari che ha come obiettivo quello di individuare le opportunità di miglioramento al fine di introdurle nella pratica professionale quotidiana. Gli assistiti che necessitano di medicazione NPWT hanno solitamente un grado di complessità medio-alta, richiedono quindi un assessment preciso ed approfondito, oltre ad una presa a carico multiprofessionale. Gli staff infermieristici necessitano di formazione specifica, consulenza medica e/o infermieristica esperta, adeguato supporto documentale ed informatico al fine di assicurare sicurezza, qualità e razionalità delle cure, outcome positivi di salute. Molti sono gli articoli scientifici e le esperienze a favore di una presa a carico infermieristica di pazienti con medicazioni complesse gestite tramite dispositivi NPWT. I presupposti affinché questo possa avvenire in sicurezza prevedono un processo definito in modo chiaro e condiviso fra professionisti sanitari ed assistiti, formazione aggiornata, documentazione corretta. During last twenty years, tailored technologies were spread and improved; they are aimed to support the treatment of difficult-toheal wounds, such as negative pressure wound therapy (NPWT). This type of treatment lead to promote healing process and to reduce hospital stay of patients. In an acute care setting, planning and managing these new technologies represent a key-point. We did a retrospective study about NPWT in acute care setting in Beata Vergine Regional Hospital in 2017, aimed at performing a clinical audit; the results were compared to scientific literature to detect differences in daily clinical practice. Audit is a very helpful tool for Clinical Government: this method leads to improve the management of clinical activities because the entire staff (physicians and nurses) obtains important data about care setting. Patients treated by NPWT are usually difficult to treat and need a correct assessment and a multidisciplinary approach. Consequently, fundamental aspects are represented by nursing staff education and its relationship with medical staff, data collections and computer-assisted technologies development. Significant scientific literature and clinical experience seem to recommend a nursing management of NPWT patients. This aspect is very interesting and it can be improved by specific education, adequate organization and correct data collection.

Faecal incontinence is a very debilitating problem. Many techniques have been proposed to treat this condition, with controversial results. Autologous transplant of fat tissue is an established procedure used for the repair of tissue damage, and recent studies revealed the potentiality of tissue regeneration by human adipose-derived stem cells. We treated this condition with the injection, in the intersphincteric anal groove, of lipoaspirate processed by an innovative technology (Lipogems). The aim of the study was to evaluate the efficacy of Lipogems injection for the treatment of faecal incontinence. In February 2014 we treated 3 patients with faecal incontinence. The surgical procedure required three phases: lipoaspiration, processing of lipoaspirate with the Lipogems system, and injection of the obtained product in the intersphincteric anal groove. An accurate proctological examination followed at 1 week, 1 month and 6 months after treatment. Each patient reported an improved Wexner incontinence score at 1 month after the procedure. We observed an increase of resting pressure (by at least 10 mm Hg) and thickness of the internal anal sphincter respectively at ano-rectal manometry and by ultrasound (US) evaluation at the sixth month of follow-up. Our preliminary results are encouraging, but multicentric studies with longer follow-up are needed to validate this novel technique for treatment of faecal incontinence.

The aim of this study was to evaluate whether changing the interval from CIDR removal to timed artificial insemination (TAI) according to the diameter of the preovulatory follicle (POF) would improve pregnancy per AI in cows. In Study 1, a retrospective analysis of TAI experiments (n=96 cows) was performed to characterize the time of ovulation according to the diameter of the dominant follicle. It was observed that cows with a larger POF had ovulations earlier than cows with smaller POF, according to the equation: y=0.72x(2)-26.74x+264.54 (R(2)=0.63; P

The use of dietary supplements for weight loss has gained significant momentum. Polyglucosamine, a chitosan derivative, is a dietary supplement increasingly used for weight loss. In this meta-analysis, we systematically summarized and quantified the key findings of four randomized, placebo-controlled clinical trials examining the effects of polyglucosamine supplementation and caloric restriction, and physical activity on body weight, body mass index (BMI), and waist circumference in subjects with overweight and obesity. The control group was set with a physical activity from 6–7 MET-h/week activity and up to 21 MET-h/week activity with caloric restriction. Compliance in the latter trials was reported via a follow-up questionnaire with the individual participants. The analysis included 399 subjects followed for a period ranging from 12 weeks to one year. Subjects’ age ranged from 21–75 years, BMI from 26–45 kg/m2, and all were white European or Caucasian in ethnicity. The meta-analyzed mean differences for random effects showed that polyglucosamine supplementation improves weight loss by −1.78 kg [−2.78, −0.79], BMI by −1.52 kg/m2 [−3.58, 0.54], and improves waist circumference reduction by −1.45 cm [−2.77, −0.12]. In conclusion, the use of polyglucosamine supplementation in conjunction with lifestyle behavioral therapies can be effective for weight reduction. Further studies are needed to examine the long-term effects of polyglucosamine supplementation on weight loss and other metabolic parameters

The present study aimed to evaluate the healing process of ulcers in the jugal mucosa of Wistar rats treated with abatacept. The rats were randomly assigned to four groups: saline-treated control (0.3 mL/kg) abatacept-treated groups at dosages of 3.2, 8.0 and 20.0 mg/kg/week. After two weeks of subcutaneous (SC) administration, ulcers were introduced into the left jugal mucosa with an 8-mm diameter punch. SC administration was continued until euthanasia (after 1, 3, 7, 14 and 21 days of ulceration), and ulcers were clinically measured and animals weighed. Histological slides were evaluated (healing scores and polymorphonuclear, mononuclear, vessel, and fibroblast/myofibroblast counts). We also performed collagenesis analysis (Picrosirius Red) and immunohistochemistry (induced nitric oxide synthase (iNOS), interleukin (IL)-1beta (1β), -6, -10, plus the analysis of CD8 and CD30). The experiment was repeated to perform a vascular permeability assay. ANOVA 1-way or 2-way/Bonferroni and Kruskal-Wallis/Dunn tests were used for statistical analysis (GraphPad Prism 5.0®, p

BackgroundThe majority of young people receive treatment for depressive symptoms in the UK from staff with minimal specialist mental health/therapeutic training. There is no evidence to guide them as to what treatments are likely to be effective. Interpersonal counselling (IPC) is a reduced form of interpersonal psychotherapy and may be an appropriate treatment to use in this population.ObjectivesTo test the effectiveness and acceptability of IPC delivered by youth workers to young people with primarily depressive symptoms.MethodsYouth workers received a 2-day training course in IPC, followed by regular supervision. They delivered IPC to 23 young people who they would normally see in their service, with depressive symptoms as their main problem. Symptoms were assessed by the Revised Child Depression and Anxiety Scale (RCADS). Qualitative interviews of youth workers and young people assessed acceptability.FindingsMean (SD) RCADS depression-T scores fell from 78.2 (11.1) to 52.9 (16.8). All young people and youth workers interviewed were positive about it. Participants detailed specific advantages of IPC above standard counselling, including practical help, the use of goals, psychoeducation and integrating a self-rated questionnaire into treatment.Conclusions and clinical implicationsIPC is likely to be an effective and acceptable treatment for young people with primarily depressive symptoms seen in local authority non-specialist mental health services. Further research is needed to determine if it is more effective than current treatment as usual.

Royal jelly may contain pollen grains and their presence can be used to determine the phytogeographical origin of the product. This study analyzed the phytogeographical origin of commercial royal jelly samples from São Paulo State, tested as part of the Brazilian Federal Inspection System (SIF), found to be contaminated with spores of the bacterium Paenibacillus larvae, that causes the American Foulbrood Disease. The pollen grains of Castanea had the highest total percentage, with lower percentages of Cirsium/Carduus, Cistus, Parthenocissus, Prunus, Quercus, Robinia, Scrophulariaceae, Taraxacum, Tilia, among others. This pollen spectrum is incompatible with royal jelly samples produced in Brazil. The pollen spectrum resembled that of an imported product, compatible with the Northern Hemisphere origin. Brazilian legislation does not require the phytogeographic origin of imported bee products to be analyzed by palynological procedures, but it is mandatory to have a certificate issued by the country of origin attesting the absence of pathogens, monitored with the objective of preventing the exotic diseases from entering Brazil. Palynology, therefore, proved to be fundamental in detecting imports of this contaminated batches. RESUMO A geléia real pode conter grãos de pólen e sua presença pode ser usada para determinar a origem fitogeográfica do produto. Este estudo analisou a origem fitogeográfica de amostras comerciais de geléia real do Estado de São Paulo, com registro no Sistema de Inspeção Federal (SIF) brasileiro, que estavam contaminadas com os esporos da bactéria Paenibacillus larvae, causadora da doença Cria Pútrida Americana. Os grãos de pólen de Castanea apresentaram a maior porcentagem total, com menores percentuais de Cirsium/Carduus, Cistus, Parthenocissus, Prunus, Quercus, Robinia, Scrophulariaceae, Taraxacum, Tilia, dentre outros. Este espectro polínico é incompatível com amostras de geléia real produzidas no Brasil. O espectro polínico assemelhou- se ao de um produto importado, compatível com a origem do Hemisfério Norte. A legislação brasileira não exige que a origem fitogeográfica dos produtos apícolas importados seja analisada por procedimentos palinológicos, mas é obrigatório ter um certificado atestando a ausência de patógenos emitido pelo país de origem, monitorado com o objetivo de impedir que doenças exóticas penetrem no Brasil. A palinologia, portanto, provou ser fundamental na detecção de importações desses lotes contaminados.

N-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) seem to prevent endothelial dysfunction, a crucial step in atherogenesis, by modulating the levels of vasoactive molecules and by influencing Na,K-ATPase activity of vascular myocytes. The activity of endothelial Na,K-ATPase controls the ionic homeostasis of the neighboring cells, as well as cell function. However, controversy exists with respect to the vascular protective effect of EPA and DHA. We argue that this dispute might be due to the use of different concentrations of EPA and DHA in different studies. Therefore, this study was designed to define an optimal concentration of EPA and DHA to investigate endothelial function. For this purpose, human endothelial cells were exposed for 24 h to different concentrations of DHA or EPA (0&ndash, 20 &mu, M) to study membrane fluidity, peroxidation potential and Na,K-ATPase activity. EPA and DHA were linearly incorporated and this incorporation was mirrored by the linear increase of unsaturation index, membrane fluidity, and peroxidation potential. Na,K-ATPase activity peaked at 3.75 &mu, M of EPA and DHA and then gradually decreased. It is noteworthy that DHA effects were always more pronounced than EPA. Concluding, low concentrations of EPA and DHA minimize peroxidation sensitivity and optimize Na,K-ATPase activity.

Increasing knowledge on blood profiles for bulls residing in an artificial insemination station is needed both for their high economic value and because they represent a homogeneous bovine sub-population with specific characteristics different from other categories of cattle. Therefore, the aims of this study were to calculate descriptive statistics for blood variables routinely collected from Holstein Friesian bulls of genetic merit; to investigate the sources of variation (age, season, and genetic merit) and to calculate the relationship among blood analytes and selection indexes calculated on their daughters. Age affected some erythrocytes series (increasing trend) and white blood cell count (decreasing trend). The seasonal factor influenced significantly mainly urea. Total bilirubin was significantly affected by genetic merit, inversely correlated with the official productive selection index. Hematologic variables were mainly correlated with production index, whereas biochemical variables, such as glucose, urea and proteins, were related to fertility index.

Highlights • Underline the possibility that a gallstone ileus can be a possibility of bowel obstruction in the elderly population. • Stimulate discussion about the surgical management of gallstone ileus and cholecystic-duodenal fistula. • Abdominal CT scan is the preferred investigation for a timely diagnosis., Introduction Gallstone ileus (GI) is characterized by a mechanical occlusion of the ileal lumen as a result of migration of one or more gallstones in the intestinal tract. Less than 1–4% of all cases of intestinal obstruction are derived from this etiology (1,2,3). Case report We present a case of small intestinal obstruction owing to a large gallstone in lower ileum in a 66 years old woman. The diagnosis was made by computed tomography, and treated successfully with an enterotomy, with a removal of a 5 cm gallstone, carried out through a longitudinal incision on the antimesenteric border. Post-operative course presented no adverse effects. Conclusion Gallstone ileus should be considered in case of bowel obstruction in the elderly population. Abdominal CT scan is the preferred investigation for a timely diagnosis.

The 2 L polyethylene glycol (PEG) lavage solution has been proved to be similarly safe and effective as 4 L PEG formulations, in spite of the reduced volume.To compare low-volume PEG-based solution combined with ascorbic acid with high-volume PEG-based solution combined with simethicon in terms of efficacy and patient tolerability.This was a single-blind prospective randomized trial. Patients were randomized to receive either 2 L PEG plus ascorbic acid (PEG+Asc) or 4 L PEG plus simethicon (PEG+Sim). The primary endpoint was overall colon cleansing evaluation, assessed by blinded investigators using Aronchick score. Secondary end points included patient compliance and tolerability and adverse events.Sixty patients received PEG+Asc and 60 received PEG+Sim. Overall bowel cleansing score was considered adequate in 81.67% of the PEG+Asc and 80% of the PEG+Sim groups, respectively. Excellent and good ratings were recorded in 11.6% and 38.3% receiving PEG+Asc as compared with 26.6% and 23.3% of patients receiving PEG+Sim. Patient tolerability and safety were similar with both the preparations.According to our data, low-volume PEG+Asc has comparable efficacy, safety, and tolerability as high-volume PEG+Sim; therefore, it can be considered as a good alternative solution for bowel preparation. More improvements are necessary to achieve the target of a perfect preparation.

Introduction: Changes in the composition of gut microflora have been associated with an increase in chronic diseases. Indican urinary concentration is one of the most common and easily assessable markers of intestinal dysbiosis. Little information is available on intestinal dysbiosis in Parkinson's disease (PD). We decided to investigate indican urinary concentrations in a cohort of PD patients. Methods: A caseecontrol study including PD patients (N ¼ 68) on treatment with levodopa (PD) or on no pharmacological treatment (De Novo, DPD; N ¼34) and an age and gender-matched healthy control group (CTR; N ¼50). Main confounders, such as nutritional habits and constipation diagnosed according to Rome III criteria, were also investigated. Results: Indican urinary concentrations were significantly higher in PD and DPD than in CTR (P < 0.001 and P < 0.01, respectively). In PD patients the concentrations were unrelated to the presence of constipation, whereas this symptom was associated with higher concentrations in controls (P ¼0.043). The frequency of dairy product consumption was also positively associated with increased concentrations (P ¼0.008). Predictors of indican concentrations were sought by multivariate linear regression analysis. The higher indican urinary concentrations found in both DPD (P ¼0.045) and PD (P ¼0.023) patients persisted after adjustment for age, gender, BMI, constipation and consumption of dairy products. Conclusions: Gut dysbiosis seems to be an important issue in PD, independently of the presence of constipation and starting from the early stages of the disease. The role of gut dysbiosis in the pathogenesis of PD deserves further investigation.

Canine platelets have been extensively studied but little is known about specific aspects such as adhesion. Platelet adhesion is a critical step during haemostasis and thrombosis as well as during inflammatory and immunopathogenic responses. The aim of this study was to evaluate the adhesive properties of canine platelets using fibrinogen and collagen as substrates immobilized on plates. Adhesion was monitored for 120 min and the effect of adenosine 5'-diphosphate (ADP) was assayed. The results showed that canine platelets displayed good adhesion activity that was significantly time-dependent. Moreover, ADP was able to enhance platelet adhesion in a dose-dependent manner. The findings aid knowledge of the adhesion process and suggest a specific role of surface platelet receptors in mediating the interaction with extracellular matrix proteins. (C) 2010 Elsevier Ltd. All rights reserved.

The practice of migratory beekeeping is based on moving honey bee (Apis mellifera) colonies between different locations to intensify agricultural production through improved pollination services. However, due to stress caused by exposure of bee hives to different environments, migratory beekeeping activities can lead colonies to greater susceptibility of these insects to pathogens and pests, thus leading to population decline and mortality. The aim of this study was to evaluate the health profile of apiaries that adopt two types of management (stationary and migratory), located in the central-eastern region of São Paulo state, Brazil, during two sampling periods, one in spring (October 2010), and one in autumn (May 2011). We collected 474 samples of honeycomb from the brood area, combs containing capped brood, adult bees that covered the brood area, and foraging bees, to evaluate the presence and prevalence of Paenibacillus larvae, Varroa destructor, Nosema apis and N. ceranae. Seasonality was identified as a determining factor in the health condition of Africanized A. mellifera colonies, causing a stronger effect on health than the type of management employed (stationary vs migratory beekeeping). The infection rates of N. ceranae were higher during the autumn in relation to the spring (387 ± 554 spores per bee in the spring and 1,167 ± 1,202 spores per bee in the autumn in stationary apiaries and 361 ± 687 spores per bee in the spring and 1,082 ± 1,277 spores per bee in the autumn in migratory apiaries). The same pattern was found for infestation rates of V. destructor (2.83 ± 1.97 in the spring and 9.48 ± 6.15 in the autumn in stationary apiaries and 3.25 ± 2.32 in the spring and 6.34 ± 6.58 in the autumn in migratory apiaries). These results demonstrate that the seasonality affects the health of A. mellifera colonies, but it does not depend on the type of management adopted (stationary or migratory).

Parkinson's disease (PD) is characterized by reduced dopaminergicactivityandpreviousanimal-modelstudieshaveshownthattheneuro-transmitter dopamine modulates EPC function and mobilization fromthebonemarrow[1].Inapilotstudy,wehaveobservedthatPDpatientshave significantly higher EPC levels than controls [2]. However, thestrength of the evidence was hampered by the small sample size, themethod used for EPC determination and the potential confoundingeffect of dopaminergic treatment. Furthermore, we did not take intoaccount the role of important confounders, such as cardiovascular(CV) risk factors and related treatments. Conversely, another studyhas reported no difference in circulating EPCs between PD patientsand controls [3].Therefore,weinvestigatedwhetherdifferencesincountsofcirculat-ing EPCs occur between PD patients and controls, and, if so, whethersuch counts are modified by dopamine-replacement therapy.We studied:– de novo (drug naive) PD patients (DPD) having at least a one-yearfollow-up