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Le attuali linee guida raccomandano di effettuare il trattamento chirurgico di stabilizzazione o sosti- tuzione protesica entro 24-48 ore dall’accesso ospedaliero, al ne di migliorare il risultato funziona- le, ridurre il rischio di mortalità, la degenza ospedaliera e le complicazioni post-operatorie. Tuttavia, la mancanza di studi randomizzati rappresenta un importantissimo limite scienti co dal momento che ad oggi la migliore evidenza scienti ca sul timing chirurgico nelle fratture di collo femore si basa esclusivamente su studi prospettici e retrospettivi. In questo articolo, viene descritto il percorso ospedaliero per il trattamento delle fratture del collo del femore nel paziente anziano analizzando i diversi passaggi volti proprio all’ottimizzazione dei tempi di attesa pre-chirurgici. Inoltre, attraverso una revisione della letteratura vengono analizzati i rapporti esistenti tra timing chirurgico, complicanze post-operatorie e mortalità..

The available levels of K+, Ca2+, Mg2+, and Na+ in bulk and rhizosphere soil of corn (Zea mays var. Forban) were evaluated by the electro‐ultrafiltration (EUF) technique. The nutrients extracted at 20°C and 200 V (EUF‐I = easily available fraction), at 80°C and 200 V (EUF‐II = available reserve), and at 80°C and 400 V (EUF‐III = retained reserve) were determined. The field experiment was carried out with four treatments, N + P + K (F1), N + P (F2), N + K (F3), and N (F4) in a completely randomized experimental design. Results revealed that the pH of rhizosphere soil was slightly lower than that of bulk soil with significant differences at 40 days after sowing (DAS). Organic carbon levels were higher in rhizosphere soil with differences that tend to increase with crop age. The EUF‐I‐K+ was significantly (P

Sono descritte le generalità e le metodiche di diagnosi e trattamento delle fratture dello scafoide carpale

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Distal radius fractures are one of the most common injuries treated by the orthopedic surgeons representing almost 1/6 of the fractures that are treated in the emergency departments and the 75% of all fractures of the upper limb and are second only to hip fractures in elderly population. The age distribution of this kind of injury is typically bimodal with peaks in the young patients (6-25) and in the elderly patients older than 65. In the first case the mechanism of injury is usually a high energy trauma, such as a car accident, whilst in the second one is usually a low energy trauma like a domestic fall. Various classification systems have been proposed for these fractures. The classic eponymy-based classification, which divides the fractures in “Colles, Smith, Hutchinson, etc” is always useful but we think that the best system could be a combination with the classic eponymy-based classification with the one proposed by the AO Trauma. Distal radius fractures are frequent in elderly active patients and are usually treated with closed reduction and cast immobilization for 5-6 weeks. Decision for surgical treatment in osteoporotic and elderly patients is difficult as there are no significant differences of functional outcome after non surgical and surgical treatment, patient’s comfort, pre- injury activity level, life style requirement, stage of osteoporosis, fracture stability, joint congruency, loss of previous reduction and bilateral fractures should be considered in decision making. Of different kinds of surgical treatment we prefer k-wires fixation, epibloc or ORIF with locking plate.

L'artrite secondaria a malattia infiammatoria cronica intestinale può essere presente parecchi anni prima della diagnosi oppure manifestarsi come una vera complicanza.

Non previsto

Le fratture del radio distale sono tra i più comuni traumi trattati dagli ortopedici rappresentando quasi un sesto delle fratture osservate al pronto soccorso e il 75% di tutte le fratture dell’arto superiore e sono seconde solo alle fratture di femore nella popolazione anziana. L’età di distribuzione di questo tipo di frattura è tipicamente bimodale con picchi nei giovani e negli anziani al di sopra dei 65 anni d’età. Nel primo caso il meccanismo traumatico è in genere un trauma ad alta energia come un incidente stradale, mentre nel secondo caso è in genere un trauma a bassa energia come una caduta. Sono stati proposti diversi sistemi classificativi per queste fratture. La classica classificazione basata su eponimi è sempre utile ma noi preferiamo affiancarvi quella proposta dall’AO. Il trattamento delle fratture del radio distale è ben documentato in letteratura e in virtù dell’aumento dell’aspettativa di vita un adeguato trattamento è sempre più importante. La decisione circa un trattamento conservativo piuttosto che chirurgico deve essere presa basandosi sul comfort del paziente, sul livello di attività prima del trauma, sullo stadio dell’osteoporosi, sulla stabilità della frattura secondo i criteri di La Fontaine, sulla perdita di una riduzione precedentemente ottenuta, sulla presenza di frattura bilaterale. È comunque importante ricordare che nei pazienti anziani le indicazioni circa il trattamento chirurgico risultano poco chiare e a volte contraddittorie mentre se si prendono in considerazione pazienti giovani in letteratura vi è unanime accordo e consenso.

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Irrigation with wastewaters from agri-industry processes such as milk factories, piggeries, wineries and abattoirs is commonplace. These wastewaters all have high levels of potassium (K). Potassium concentration in effluents from domestic wastewater sources are relatively low, reported to vary between 10 and 30mgL−1. Higher levels of potassium are reported for effluents from olive oil mills, 10,000–20,000mgKL−1, wool scouring, 4200–13,000mgKL−1, cheese and lactic whey and potato processing, ∼1800mgKL−1, piggery effluent, 500–1000mgKL−1 and winery wastewaters, up to 1000mgKL−1. Application of wastewaters with these high potassium levels has been found to increase the overall level of soil fertility, with the exception of alkaline effluents which can dissolve soil organic carbon. Long-term application of suchwastewater may cause the build-up of soil potassium and decrease the hydraulic conductivity of the receiving soils. These potential impacts are uncertain and have been inadequately researched. Regulatory limits for potassium in drinking water have been set only by the European Union with no toxicological or physiological justification. The literature shows that grasses and legume herbages accumulate high levels of potassium, up to 5% dryweight, and some grasses, such as turfgrass are particularly tolerant to high levels of potassium, even under saline conditions. This adaptation is considered useful for increasing potassium immobilization and sustainable practices of land wastewater disposal. Potassium availability is significantly affected by the cation ratios of thewastewater, the existing soil water solution and of soil exchange sites

Introduction and Objectives: Intravesical chemotherapy has been proven effective in preventing recurrence of low-risk non-muscle invasive bladder cancer (NMIBC). BCG is recognised as the best conservative treatment for intermediate and high risk NMIBC. Maintenance for at least one year is required to ameliorate the efficacy of adjuvant therapy. Discomfort and toxicity often cause interruption of adjuvant therapy, BCG particularly. Almost 50% of the patients undergoing BCG does not complete one year. A biomarker of urothelium damage would be helpful for timely detection of toxicity in order to ameliorate patient’s tolerance and compliance. The aim of the present study was to evaluate the gene expression of Fibronectin (FN) in bladder washing in relation with local toxicity due to adjuvant intravesical therapy. Patients and Methods: Out of 26 asymptomatic patients undergoing intravesical prophylaxis with mitomycin (40 mg/40 ml), epirubicin (80 mg/50 ml) or BCG Connaught (81 mg/50 ml) and 10 volunteers as control group, 62 samples of bladder washing were collected before, during and after therapy. The samples were analyzed by isolation of cellular RNA using a miRNeasy Mini Kit (Qiagen®). FN gene expression was analyzed by RT-PCR. The ΔΔCt method after normalization with endogenous reference 18s rRNA was adopted. An average Ct value for each RNA was obtained for triplicate reactions. Local toxicity was classified into 3 grades: 0-1. mild (no medical therapy); 2. moderate (medical therapy); 3. severe (instillation postponed for 1-2 weeks or intravesical solution of hyaluronic acid and chondroitin sulphate administered). Results: FN gene expression, compared to controls, was increased 1.1 fold after TUR and before intravesical therapy. During therapy it remained unchanged (1.0 fold). However it was increased 1.1 fold in absence of local toxicity, but to a median value of 3.6 fold in presence of severe toxicity. Particularly, the mean values, compared to controls, were 2.4 (range: 0.3-6.1), 1.1 (range: 0.1-2.3), 9.3 (range: 0.2-45.2), before therapy, in absence and in presence of local toxicity, respectively. Of interest, patients receiving intravesical hyaluronic acid and chondroitin sulphate solution showed a median FN gene expression of 0.2 fold (range 0.1- 0.7), decreasing from 3 to 0.6 and from 4 to 0.2 fold in two patients contemporary with symptomatic relief. Discussion: Few studies have correlated the gene expression of FN to bladder urothelial damage, in interstitial cystitis (1). FN plays an important role on BCG activity (2). A marker of topical toxicity would be helpful to improve the tolerance and to reduce the drop-out rates of intravesical therapy. The measurement in bladder washing is a simple and direct evaluation of urothelial FN gene activity. This method avoids all the bias due to the evaluation of FN protein expression in urine. The overexpression of FN gene indicates the presence of urothelial damage and activation of repairing processes. Normal and downexpression indicate the absence or healing of urothelial damage. Preliminarily, our study shows a significant correlation between FN gene expression on bladder washing and local toxicity. Furthermore, FN seems to be reduced by the intravesical administration of intravesical hyaluronic acid and chondroitin sulphate solution. Conclusion: FN gene expression in bladder washing emerges as a simple and promising marker of urothelial damage. Further and larger studies should be justified. Acknowledgements: We wish to thank IBSA for unrestricted grant and the GSTU Foundation for administrative support. 1 Blalock EM et al: Gene expression analysis of urine sediment: evaluation for potential noninvasive markers of interstitial cystitis/bladder pain syndrome. J Urol 187: 725, 2012. 2 Eissa S et al: Diagnostic value of fibronectin and mutant p53 in the urine of patients with bladder cancer: impact on clinicopathological features and disease recurrence 27: 1286, 2010.