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Background: The Massachusetts General Hospital is a large, quaternary care institution with 58 operating rooms, 164 anesthesiologists, 76 certified nurse anesthetists (CRNAs), an anesthesiology residency program that admits 25 residents annually, and 35 surgeons who perform laparoscopic, vaginal, and open hysterectomies. In March of 2018, our institution launched an Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing hysterectomy. To implement the anesthesia bundle of this pathway, an intensive 14-month educational endeavor was created and put into effect. There were no subsequent additional educational interventions., Methods: We retrospectively reviewed records of 2570 patients who underwent hysterectomy between October 2016 and March 2020 to determine adherence to the anesthesia bundle of the ERAS Hysterectomy pathway., Results: Increased adherence to the four elements of the anesthesia bundle (p < 0.001) was achieved during the intervention period. Compliance with the pathway was sustained in the post-intervention period despite no additional actions., Conclusions: Implementing the anesthesia bundle of an ERAS pathway in a large anesthesia group with diverse providers successfully occurred using implementation science-based approach of intense interventions, and these results were maintained after the intervention ceased.

Background: Spinal muscular atrophy (SMA) is a chronic, neuromuscular disease characterized by degeneration of spinal cord motor neurons, resulting in progressive muscular atrophy and weakness. SMA1 is the most severe form characterized by significant bulbar, respiratory, and motor dysfunction. SMA1 prevents children from speaking a clearly understandable and fluent language, with their communication being mainly characterized by eye movements, guttural sounds, and anarthria (type 1a); severe dysarthria (type 1b); and nasal voice and dyslalia (type 1c). The aim of this study was to analyze for the first time cognitive functions, language comprehension, and speech in natural history SMA1 children according to age and subtypes, to develop cognitive and language benchmarks that provide outcomes for the clinical medication trials that are changing SMA1 course/trajectory., Methods: This is a retrospective study including 22 children with SMA1 (10 affected by subtype 1a-1b: AB and 12 by 1c: C) aged 3-11 years in clinical stable condition with a coded way to communicate "yes" and "no". Data from the following assessments have been retrieved from patient charts: one-dimensional Raven test (RCPM), to evaluate cognitive development (IQ); ALS Severity Score (ALSSS) to evaluate speech disturbances; Brown Bellugy modified for Italian standards (TCGB) to evaluate language comprehension; and Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) to assess motor functioning., Results: SMA 1AB and 1C children were similar in age, with the former characterized by lower CHOP-INTEND scores compared to the latter. All 22 children had collaborated to RCPM and their median IQ was 120 with no difference (p = 0.945) between AB and C. Global median score of the speech domain of the ALSSS was 5; however, it was 2 in AB children, being significantly lower than C (6.5, p < 0.001). TCGB test had been completed by 13 children, with morphosyntactic comprehension being in the normal range (50). Although ALSSS did not correlate with both IQ and TCGB, it had a strong (p < 0.001) correlation with CHOP-INTEND described by an exponential rise to maximum., Conclusions: Although speech and motor function were severely compromised, children with SMA1 showed general intelligence and language comprehension in the normal range. Speech impairment was strictly related to global motor impairment.

Polylactic acid (PLA) films containing 1 wt % and 3 wt % of lignin nanoparticles (pristine (LNP), chemically modified with citric acid (caLNP) and acetylated (aLNP)) were prepared by extrusion and characterized in terms of their overall performance as food packaging materials. Morphological, mechanical, thermal, UV-Vis barrier, antioxidant and antibacterial properties were assayed; appropriate migration values in food simulants and disintegration in simulated composting conditions were also verified. The results obtained indicated that all lignin nanoparticles succeeded in conferring UV-blocking, antioxidant and antibacterial properties to the PLA films, especially at the higher filler loadings assayed. Chemical modification of the fillers partially reduced the UV protection and the antioxidant properties of the resulting composites, but it induced better nanoparticles dispersion, reduced aggregates size, enhanced ductility and improved aesthetic quality of the films through reduction of the characteristic dark color of lignin. Migration tests and disintegration assays of the nanocomposites in simulated composting conditions indicated that, irrespectively of their formulation, the multifunctional nanocomposite films prepared behaved similarly to neat PLA.

Background: In mechanically ventilated acute respiratory distress syndrome (ARDS) patients infected with the novel coronavirus disease (COVID-19), we frequently recognised the development of pneumomediastinum and/or subcutaneous emphysema despite employing a protective mechanical ventilation strategy. The purpose of this study was to determine if the incidence of pneumomediastinum/subcutaneous emphysema in COVID-19 patients was higher than in ARDS patients without COVID-19 and if this difference could be attributed to barotrauma or to lung frailty., Methods: We identified both a cohort of patients with ARDS and COVID-19 (CoV-ARDS), and a cohort of patients with ARDS from other causes (noCoV-ARDS).Patients with CoV-ARDS were admitted to an intensive care unit (ICU) during the COVID-19 pandemic and had microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. NoCoV-ARDS was identified by an ARDS diagnosis in the 5 years before the COVID-19 pandemic period., Results: Pneumomediastinum/subcutaneous emphysema occurred in 23 out of 169 (13.6%) patients with CoV-ARDS and in three out of 163 (1.9%) patients with noCoV-ARDS (p<0.001). Mortality was 56.5% in CoV-ARDS patients with pneumomediastinum/subcutaneous emphysema and 50% in patients without pneumomediastinum (p=0.46).CoV-ARDS patients had a high incidence of pneumomediastinum/subcutaneous emphysema despite the use of low tidal volume (5.9±0.8 mL·kg -1 ideal body weight) and low airway pressure (plateau pressure 23±4 cmH 2 O)., Conclusions: We observed a seven-fold increase in pneumomediastinum/subcutaneous emphysema in CoV-ARDS. An increased lung frailty in CoV-ARDS could explain this finding more than barotrauma, which, according to its etymology, refers to high transpulmonary pressure., Competing Interests: Conflict of interest: D.H.L. Lemmers has nothing to disclose. Conflict of interest: M. Abu Hilal has nothing to disclose. Conflict of interest: C. Bnà has nothing to disclose. Conflict of interest: C. Prezioso has nothing to disclose. Conflict of interest: E. Cavallo has nothing to disclose. Conflict of interest: N. Nencini has nothing to disclose. Conflict of interest: S. Crisci has nothing to disclose. Conflict of interest: F. Fusina has nothing to disclose. Conflict of interest: G. Natalini has nothing to disclose., (Copyright ©ERS 2020.)

Background: Aging and mortality of patients on waiting lists for kidney transplantation have increased, as a result of the shortage of organs available all over the world. Living donor grafts represent a significant source to maintain the donor pool, and resorting successfully to allografts with arterial disease has become a necessity. The incidence of renal artery fibromuscular dysplasia (FMD) in potential living renal donors is reported to be 2-6%, and up to 4% of them present concurrent extra-renal involvement., Case Presentation: We present a case of renal transplantation using a kidney from a living donor with monolateral FMD. Resection of the affected arterial segment and its subsequent replacement with a cryopreserved iliac artery graft from a deceased donor were performed. No intraoperative nor post-operative complications were reported. The allograft function promptly resumed, with satisfying creatinine clearance, and adequate patency of the vascular anastomoses was detected by Doppler ultrasounds., Conclusion: Literature lacks clear guidelines on the eligibility of potential living renal donors with asymptomatic FMD. Preliminary assessment of the FMD living donor should always rule out any extra-renal involvement. Whenever possible, resection and reconstruction of the affected arterial segment should be taken into consideration as this condition may progress after implantation.

Organophosphate pesticides are frequently used to eliminate or prevent insects in poultry. However, their residues may continue in meat after slaughtering. In this study, proteomics and peptidomics approaches were used to evaluate their oxidative impact on myosin and chicken breast proteins under in vitro conditions. Myosin protein was exposed to diazinon and chlorpyrifos showing an increase in its oxidation by increasing times, especially with chlorpyrifos. Then, chicken breast was contaminated with chlorpyrifos to evaluate carbonylation and the effect of simulated gastrointestinal digestion. Proteins were isolated using size-exclusion-chromatography and identified by mass spectrometry in tandem. Myosin, β-enolase, CK-M-type and actin were identified as main proteins susceptible to oxidation. Also, oxidised peptides obtained before and after simulated gastrointestinal digestion were identified. Collagen peptides the most susceptible to oxidation. These results suggest that the presence of chlorpyrifos residues on meat could have a negative effect on its final quality and nutritional value., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Chlorpyrifos (CPF) is an organophosphorus pesticide used in poultry to prevent and/or kill insects and such as preserving agents of poultry feed. Exposure continues to CPF can promote its accumulation at trace concentrations in animal tissue. The toxicological effects of these residues (carcinogenicity, genotoxicity, and neurological disorders) have been related to oxidative stress. Nevertheless, it is still unknown if these trace concentrations might promote oxidative stress in muscle proteins since chicken meat proteins are susceptible to undergo oxidation reactions. Moreover, protein oxidation has been related to a decrease in the nutritional value in of meat. To investigate the oxidative effect of CPF on chicken breast proteins, peptidomics and proteomics analysis were used. For this, chicken breast samples were exposed to CPF and subjected to simulated gastrointestinal digestion. The identification of oxidized peptides from digested and undigested proteins were performed by LC MS/MS (nanoESI qQTOF). Prior to mass analyses undigested proteins were trypsinated. Data were analysed using MASCOT and ProteinPilot v 4.5 software. In this study, 90 and 107 oxidized peptides from digested proteins of control and exposed samples were identified, respectively. These peptides corresponding to 12 oxidized proteins. Meanwhile, 260 and 324 oxidized peptides from undigested proteins (control and exposed samples) were identified, which corresponding to 19 and 17 proteins, respectively. Collagen was protein more susceptible to oxidation promoted by chlorpyrifos in digested and undigested proteins. Identification of these oxidized proteins from simulated digestion provides an important insight about the impact of substances like certain veterinary drugs at trace concentrations on the nutritional value of chicken breast meat., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article., (© 2020 The Authors.)

Objectives : Safety pictograms are important graphic elements that are useful for rapidly conveying messages in workplaces. The purpose of this study was to investigate the comprehension of safety pictograms affixed to agricultural machinery among a group of Pakistani migrant farmworkers employed in Italy. Methods : Interviews about the meanings attributed to four standardized safety pictograms affixed to agricultural machinery depicting the most frequent causes of farm accidents were administered to 29 Pakistani migrant farmworkers employed on Italian farms. Results : There was high variability in pictogram comprehension. None of the participants interpreted all the pictograms in accordance with the definitions provided by the international standards. Higher comprehension rates were reported for pictograms related to the risks of tractor rollover and foot injury, while pictograms referring to the need to consult a technical manual and the risk of entanglement yielded lower comprehension scores. Previous farming experience in the country of origin and the number of years of education were significantly associated with comprehension scores. Conclusion : A discussion of pictogram features that may be critical for comprehension is provided, and (re)design suggestions are given to improve the cross-cultural comprehension of these safety signs.

During the last two decades cellulosic nanomaterials have been the subject of much research around the world. Moreover, in the last few years, increasing industrial interest on the field enabled the setting-up of the first facilities producing commercial quantities of nanocelluloses; whereas a number of inventions involving cellulose nano-objects are claimed every year. In this context, the current article describes the recent evolution (from 2010 till 2017) of published patents which explicitly include in their title, abstract and/or claims references to cellulose nano-objects such as cellulose nanocrystals, cellulose nanofibrils and bacterial nanocellulose. Results evidence the astonishing increase in nanocellulose patents since 2010, and specially within the last three years surveyed (i.e. 2015-2017), when published documents accounted for ca. 70 % of the total number of patents published since 2010. Besides patent timelines, data is analysed in terms of patent owners, countries of application, and citing number., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest that are directly relevant to the content of this article., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Lectures are the most commonly used training method but may not be effective in communicating safety information among migrant workers because of language and cultural barriers. The comprehension of safety information is particularly urgent in highly hazardous sectors such as agriculture, which has a high migrant workforce rate. In this study, an ergonomic user-centred approach was adopted to develop and evaluate safety training material targeting migrants employed on Italian farms. Focus groups with both trainers and migrants were carried out to collect information on critical issues in traditional training material, the most and least comprehended topics and suggestions for training improvement. Based on the focus group analysis, the training material was developed considering several visual factors and more engaging interaction between trainers and migrant trainees. The usability of the developed material was then evaluated in a group of 20 migrant farmworkers through a questionnaire assessing the knowledge of safety information before (T0) and after (T1) the training (effectiveness), perceived effort in learning (efficiency) and user satisfaction after training. The results showed improved knowledge, low perceived effort and high satisfaction, pointing to the positive effects of active user involvement when designing targeted training materials.

4-HNE-modified ankyrins have been described in diseases such as diabetes, renal failure, G6PD deficient, sickle cell trait, and P. falciparum infected erythrocytes with different AB0 blood groups. However, effects at the atomic level of this carbonylation on structure and function of modified protein are not yet fully understood. We present a study based on molecular dynamics simulations of nine 4-HNE modified residues of the ZU5-ANK ankyrin domain with β-spectrin and their binding energy profiles. Results show that 4-HNE induced local conformational changes over all protein systems evaluated, increased mobility in the modification sites, and localized structural changes between the positively charged patch of the ZU5-ANK domain. Carbonylation with 4-HNE on lysine residues decreased the affinity between ZU5-ANK and the 14-β-spectrin repeat by reducing electrostatic and van der Waals interactions. The presented work provides further insight into understanding the loss of human erythrocyte deformation capacity under conditions of oxidative stress in different diseases.

The data described here supports a part of the research article "Effect of 4‑HNE Modification on ZU5-ANK Domain and the Formation of Their Complex with β‑Spectrin: A Molecular Dynamics Simulation Study" [1]. Dataset on Gaff force field parameters of AMBER is provided for the non-standard arginine resulting of reaction with 4-hydroxy-2-nonenal (4-HNE), the major secondary product of lipids peroxidation. Arg-HNE 2-pentilpyrrole adduct is part of the 4-hydroxyalkenals described in various physiopathological disorders related to increased oxidative stress. Data include a framework for derivation of missing bonds, angles and dihedral parameters for modified arginine, alongside optimized partial charges derived with Restrained Electrostatic Potential (RESP) method and the new force field parameters obtained by quantum mechanicals methods (QM) using Hartree-Fock (HF)/6 - 31G** level of theory. Benchmark as a graphics tutorial summary steps to obtained new parameters and the validation of non-standard amino acids is presented. The new residue constructed is put available to the scientific community to perform molecular dynamics simulations of modified 4-HNE proteins on arginine residue and complete the set of data parameters for nucleophilic residues with this reactive aldehyde ADDIN EN.CITE ADDIN EN.CITE.DATA [2]. Data that could be used for the researchers interested in the role of protein oxidation as mediator in cellular pathophysiological., (© 2020 The Authors.)

Although the impact of oxidation on human health has been of growing interest, the oxidation of proteins, major component of meat, has received little attention. This paper describes the in vitro effect of five fluoroquinolones (FQs) on carbonylation of sarcoplasmic and myofibrillar proteins of beef when found at concentrations close to the maximum residue limit (MRL). Samples were treated individually with the FQs, determining in each protein fraction the carbonyl index, protein content and oxidized proteins identification, using 2,4-dinitrophenyhydrazine (DNPH) alkaline assay, Western blot and Bradford methods, and mass spectrometry, respectively. Besides, the in vitro effect of these residues on gastric and duodenal digestion of proteins was evaluated. The carbonylation induced by FQs affected both protein fractions being significant with respect to the blank in 73.3% of cases. This damage was correlated with loss of solubility and digestibility, with sarcoplasmic proteins the most affected. Danofloxacin and enrofloxacin were the FQs with greatest oxidant effects, especially affecting glycolysis and glycogen proteins. Our results suggest that these residues induce irreversible oxidative damage on the main beef proteins and could affect their nutritional value., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of the data; in the writing of the manuscript; or in the decision to publish the results.

Objective: To identify the critical behaviors that may hinder the correct use of foldable rollover protective structures (FROPS) on tractors and to explore the influence of user factors and FROPS technical characteristics., Background: FROPS are effective in preventing fatal injuries in rollover accidents if they are in the upright position. However, many farmers leave FROPS folded down., Method: Twenty farmers and sixteen models of tractors were involved in the study. Operators were observed while raising the FROPS, and the observed behaviors were correlated with user factors and FROPS technical features., Results: In the initial rotation of the FROPS, higher lowered roll-bar to ground distance and FROPS pivot-pin to ground distance required more awkward and unbalanced postures ( p = .02 and p = .01, respectively). When rotating the FROPS in upright position, smaller stature of the participants and higher FROPS pivot-pin to ground distance were significantly correlated with using the tractor's rear 3-point lower links as a supporting surface ( p = .01 and p = .02, respectively)., Conclusion: FROPS might be revised considering users' comfort in use and anthropometric variability, to improve reachability, avoid risky behaviors, and enhance FROPS operation., Application: Technical solutions to enhance FROPS accessibility may be developed, particularly by providing safe surfaces to support operators and highlighting the grasping points. Further best practices and information on correct gestures to handle the FROPS should be included in the tractor manual.

The presence of hemoglobin A-S (HbAS) in erythrocytes has been related to the high production of reactive oxygen species (ROS) and an increased in intracellular oxidative stress that affects the progress of Plasmodium erythrocytic cycle life and attenuates its serious clinical symptoms. Nevertheless, oxidative effects on P. falciparum proteome across the intraerythrocytic cycle in the presence of HbAS traits have not been described yet. Here, an immune dot-blot assay was used to quantify the carbonyl index (C.I) on P. falciparum 3D7 proteome at the different asexual erythrocytic stages. Protein carbonylation on parasites cultivated in erythrocytes from two donors with HbAS increased 5.34 ± 1.42 folds at the ring stage compared to control grown in hemoglobin A-A (HbAA) red blood cells. Whereas at trophozoites and schizonts stages were augmented 2.80 ± 0.52 and 3.05 ± 0.75 folds, respectively. Besides proteins involved in processes of the stress response, recognition and invasion were identified from schizonts carbonylated bands by combining SDS-PAGE with MALDI-TOF-TOF analysis. Our results reinforce the hypothesis that such oxidative modifications do not appear to happen randomly, and the sickle cell trait affects mainly a small fraction of parasite proteins particularly sensitive to ROS.

Heavy metal tolerant plants have phytoremediation potential for the recovery of contaminated soils, and the characterization of their metabolic adaptation processes is an important starting point to elucidate their tolerance mechanisms at molecular, biochemical and physiological levels. In this research, the effects of Cd and Pb on growth and protein carbonylation in tissues of Paspalum fasciculatum exposed to 30 and 50 mg·Kg -1 Cd and Pb respectively were determined. P. fasciculatum seedlings exposed to metals grew more than controls until 60 days of cultivation and limited their oxidative effects to a reduced protein group. Carbonyl indexes in leaf and root proteins reached a significant increase concerning their controls in plants exposed 30 days to Cd and 60 days to Pb. From the combined approach of Western Blot with Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE) and protein analysis by Matrix Asisted Laser Desorption/Ionisation - Time Of Flight (MALDI-TOF/TOF) mass spectrometry, chloroplastic proteins were identified into the main oxidative stress-inducible proteins to Cd and Pb, such as subunits α, γ of ATP synthetase, Chlorophyll CP26 binding protein, fructose-bisphosphate aldolase and long-chain ribulose bisphosphate carboxylase (RuBisCO LSU). Cd generated damage in the photosynthetic machinery of the leaves of P. fasciculatum into the first 30 days of treatment; five of the oxidized proteins are involved in photosynthesis processes. Moreover, there was a proteolytic fragmentation of the RuBisCO LSU. Results showed that intrinsic tolerance of P. fasciculatum to these metals reached 60 days in our conditions, along with the bioaccumulating appreciable quantities of metals in their roots., Competing Interests: The authors declare that there is no conflict of interest.

The comprehension of safety signs affixed to agricultural machinery is fundamental to warning users about the residual risks which cannot be eliminated with machinery design and the adoption of protections. This is particularly relevant for the migrant workforce, which may encounter some language barriers with written safety communication. The present study aimed to investigate the comprehension of safety signs affixed to agricultural machinery in a group of migrants from both European and non-European countries employed in Italian agriculture. Thirty-seven migrant farmworkers (12 Indians, 17 Pakistanis, and eight Romanians) were individually interviewed to test the comprehension of four safety signs referring to the main causes of fatal and non-fatal injuries caused by interactions with farm machinery. Romanians obtained the highest comprehension performance (68.8% of correct answers), followed by Indians (35.4%), with Pakistanis being last (32.4%). The nationality and the previous experience as a farmworker significantly affected the comprehension of safety signs. The results pointed out the importance of adequately training migrants on the meaning of safety signs. Beside this, the study suggests a redesign of the signs, considering some signs' features to enhance pictorials' cross-cultural comprehension., Competing Interests: The authors declare no conflict of interest.

The Caribbean Coast of Colombia has a flourishing plastic industry with weak and insufficient waste management policies and practices, leading to plastic pollution along its touristic beaches. In this work, primary and secondary microplastics (MPs) were surveyed at four different locations along the Colombian Caribbean Coast. Primary microplastics, specifically white new plastic pellets, represented the largest amount of MPs found, with densities decreasing in the order Cartagena > Coveñas > Puerto Colombia > Riohacha. This distribution was connected to the vicinity of MPs sources, marine currents and wind direction. The presence of secondary MPs was associated with urban centers and proximity to river mouths. The FTIR characterization showed polyethylene as the predominant resin type, with different degrees of surface oxidation. Aqueous extracts from sampled MPs were tested on Caenorhabditis elegans. Secondary MPs elicited greater toxicological responses than pellets, especially those from Cartagena Bay, suggesting MPs act as carriers for biologically-active pollutants., (Copyright © 2019. Published by Elsevier Ltd.)

The nursing professional who treats critically ill children with cerebral injury is a key element within the pediatric intensive care team, since, through exhaustive assessment, plans nursing care in an integral manner aimed at the child and the family, and plays an essential role in the care of patients mainly at the hospital level (as well as at home). Therefore, the role played by nursing in the care of children with severe brain trauma is crucial. This guide offers nursing recommendations on neurocritical care, focusing on a systemic view based on nursing diagnoses according to the North American Nursing Diagnosis Association., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

The analysis of the postural attitude of workers during the interaction with workstation's elements and working environment is essential in the evaluation and prevention of biomechanical overload risk in workplaces. RULA (Rapid Upper Limb Assessment) and REBA (Rapid Entire Body Assessment) are the two easiest methods for postural risk assessment in the workplace. Few studies investigated postural risk in forestry sector with regard to human⁻machine interaction, in particular manually fed wood-chippers. The aim of this study was to evaluate the postures assumed by an operator during the manual feeding of a wood-chipper, and to compare RULA and REBA, in order to identify the more effective and appropriate method for the assessment of the risk of biomechanical postural overload. The results pointed out several postural issues of the upper limbs, and showed that RULA is a more precautionary method to protect operator's health during the targeted tasks. Implications to improve the human⁻wood-chipper interaction are discussed.

Steep slopes are the main cause of rollover incidents in agriculture. Targeted safety signs have been developed to warn machinery operators against risky slopes. However, machinery user's manuals and road signs report information regarding slope steepness in two different ways, by using the tilt angle in degrees and the slope percentage, respectively. In this study, we investigated the comprehension of safety signs depicting critical slopes, either in degrees or as percent values in a group of Italian agricultural machinery operators while considering the possible influence of previous experience with agricultural machinery, previous incidents, and on-farm occupation. Eighteen tractor and self-propelled machinery operators were administered graphical representations of seven slope angles in a randomized order and then were asked to estimate the slope steepness as both a tilt angle and a slope percentage. The participants tended to overestimate slope steepness in degrees, whereas the opposite was true for percentages. Farmers who were previously involved in a machinery-related incident were more accurate in their estimates. The present results raise some considerations regarding the need to redesign safety communication and to promote targeted training interventions.

Microplastics are new pollutants considered a source of concern for the oceans worldwide. This research reports the concentrations of trace metals on microplastics collected on beaches from Cartagena, an industrialized city in the Caribbean. Mercury (Hg) was quantified using a Hg analyzer and forty-seven trace elements were assessed by ICP/MS. Most abundant microplastics in beaches were those with the lower degree of surface degradation features (SDF), categorized as white-new polyethylene pellets, followed by secondary microplastics (SM). Greater Hg levels were found in SM, white-degraded (WDP) and black pellets. Trace elements concentrations were linked to the degree of SDF registered in examined pellets, with larger concentrations in WDP. Compared to white-new pellets, Ba, Cr, Rb, Sr, Ce, Zr, Ni, Pb were the most accumulated elements in WDP, as their surface enhance the sorption processes. Microplastic pollution represents a toxicological hazard because its ability to accumulate and transport toxic elements., (Copyright © 2018. Published by Elsevier Ltd.)

4-hydroxy-2-nonenal (4-HNE) is the main end product of peroxidation in lipids, capable of introduce carbonyl groups to nucleophilic amino acids via Michael additions and alter protein function. It has been reported that 4-HNE protein carbonylation is associated with intracellular protein aggregation, the pathogenesis of neurodegenerative and metabolic diseases and yet it is unclear how the carbonylation affects the protein structure and dynamics at the atomic level. Here, we analysis the structural effects of 4-HNE modification through formation of Michael adducts of Cys-4HNE, His-4HNE and Lys-4HNE on Serum Albumin (BSA) and Thioredoxin (TRX). Since both proteins have experimental evidence to possess 4-HNE-modifications on cysteine, histidine and lysine residues, extended molecular dynamics simulations were performed with AMBER to study the carbonylation effects in the structure of these proteins. BSA is the main protein of plasma while TRX is an important antioxidant enzyme. Results showed local changes and alteration in the conformational stability, folding and flexibility after including the 4-HNE modification. DSSP analysis showed important structural modifications as a consequence of the inclusion of the modified residues. Analysis of the computed trajectories suggests that 4-HNE decreases stability, increases local flexibility and produced modest unfolding on both tested proteins. Finally, all the systems evaluated shown an increase in the lipophilic potential and a modest decrease in the electrostatic potential in BSA but an increase in TRX., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Deficiency of glucose-6-phosphate dehydrogenase (G6PD) and sickle cell trait (SCT) are described as the polymorphic disorders prevalent in erythrocytes. Both are considered the result of the selective pressure exerted by Plasmodium parasites over human genome, due to a certain degree of resistance to the clinical symptoms of severe malaria. There exist in both a prooxidant environment that favors the oxidative damage on membrane proteins, which probably is part of molecular protector mechanisms. Nevertheless, mechanisms are not completely understood at molecular level for each polymorphism yet, and even less if are commons for several of them. Here, synchronous cultures at high parasitemia levels of P. falciparum 3D7 were used to quantify oxidative damage in membrane proteins of erythrocytes with G6PD deficient and SCT. Carbonyl index by dot blot assay was used to calculate the variation of oxidative damage during the asexual phases. Besides, protein carbonylation profiles were obtained by Western blot and complemented with mass spectrometry using MALDI-TOF-TOF analysis. Erythrocytes with G6PD deficient and SCT showed higher carbonyl index values than control and similar profiles of carbonylated proteins; moreover, cytoskeletal and stress response proteins were identified as the main targets of oxidative damage. Therefore, both polymorphisms promote carbonylation on the same membrane proteins. Finally, these results allowed to reinforce the hypothesis of oxidative damage in erythrocyte membrane proteins as molecular mechanism of human adaptation to malaria infection., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The data described here support the research article "4-HNE carbonylation induces local conformational changes on bovine serum albumin and thioredoxin. A molecular dynamics study" (Alviz-Amador et al., 2018) . Dataset on Gaff force field parameters of AMBER is provided for assembled three non-standard amino acids resulting of the 4-HNE Michael addition, the main end product of lipids peroxidation. Data include a framework for derivation of missing bonds, angles and dihedral parameters for Cys, His, and Lys modified amino acids, alongside optimized partial charges derived with Restrained Electrostatic Potential (RESP) method and the new force field parameters obtained by quantic mechanical (QM) using HF/6-31G** level of theory. Benchmark as a graphics tutorial summary steps to obtained new parameters and the validation of non-standard amino acids is presented. The new residues constructed are put available to the scientific community to perform molecular dynamics simulations of modified 4-HNE proteins.

Erosional processes are highly affected by seasonal climatic fluctuations and soil management practices. Controlled grass cover is one of the most used soil conservation practices adopted in temperate climates, even if the protective effect of grass cover may decrease according to seasonal pattern. This technique is effective and, thus, widely adopted in the inter-rows of orchards such as olives, citrus or vineyards. This study reports the erosive events recorded in two different rain-fed hillslope vineyards with different rows orientation located in the Monferrato region, NW Italy. The study is addressed at compare the effects of different inter-row managements and rainfall characteristics on runoff and soil loss in hillslope vineyards (average slope from 15% to 35%). Rainfall, runoff and erosion variables were monitored in hydraulically bounded vineyard plots, where the inter-rows were managed with tillage and grass cover. Seventy-two erosive events were recorded in the period 1992-1996 in two vineyard plots with rows along the contour lines while 86 erosive events were recorded in two plots with rows up-and-down the slope from 2000 to 2014 (158 erosive events and four plots in total). Events were classified according to rainfall characteristics as "long-lasting", "intense" and "normal". In plots with rows along the contour lines, "intense" events were responsible for the highest mean soil loss in tilled plots (0.7 Mg ha -1 ) with very high erosion rates (12.3 Mg ha -1 ) observed during a single storm. In plots with rows up-and-down the slope the highest erosion rates, 21.2 and 3.4 Mg ha -1 , were recorded during fall "long-lasting" events in the tilled and grass cover plots respectively. The grass cover proved to be effective in decreasing runoff and soil losses during most of the events (at least 68% and 61% of the occurrences, respectively) reducing soil losses especially during summer storms when most of the "intense" events occured. Furthermore, the results show the fundamental role of contour-slope row orientation in reducing runoff and soil losses, disregarding the inter-rows soil management that is adopted., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aims: Chronic pre-treatment with statins may reduce mortality and morbidity in patients experiencing acute coronary syndromes (ACS), but mechanisms accounting for these findings are not completely understood., Methods and Results: The optical coherence tomography (OCT)-Formidable registry retrospectively enrolled 285 consecutive patients with ACS undergoing OCT in 9 European centres. Mean age was 60.4 ± 12.8 years, 148 (51.9%) patients had hyperlipemia, 45 (15.8%) diabetes mellitus and 142 (49.8%) presented with ST Segment Elevation Myocardial Infarction (STEMI). Patients were stratified according to statin prescription: 150 (52.6%) were on chronic pre-treatment with statins before ACS and were more likely to present with non-ST segment elevation acute coronary syndromes (NSTE-ACS) at admission (111, 74%) rather than STEMI, while the opposite was observed for patients not on statins. The primary end-point of ruptured plaque at OCT occurred significantly less frequently in the patients on chronic pre-treatment with statins [odds ratio (OR) 0.375, 95% confidence interval (CI) 0.185-0.759, P = 0.006]. The secondary end-point of thin-cap fibro-atheroma (TCFA) at any site was significantly less frequent in the statin group (OR 0.423, 95%CI 0.213-0.840, P = 0.014). No differences were observed for the secondary end-point of not-ruptured TCFA as the culprit lesion. Pre-specified sensitivity analysis was conducted according to the pattern of ACS: the reported differences were confirmed for NSTE-ACS patients, with a trend towards less plaque rupture and a significant reduction of TCFA at any site with statins, but not for STEMI., Conclusions: Chronic pre-treatment with statins is associated with a reduced prevalence of ruptured plaques in patients presenting with ACS, particularly in those with NSTE-ACS. Statins bear hence the potential to reduce morbidity during the acute phase of ACS.

Objective We investigated the risk factors for falls when egressing from agricultural tractors, analyzing the role played by worked hours, work experience, operators' behavior, and near misses. Background Many accidents occur within the agricultural sector each year. Among them, falls while dismounting the tractor represent a major source of injuries. Previous studies pointed out frequent hazardous movements and incorrect behaviors adopted by operators to exit the tractor cab. However, less is known about the determinants of such behaviors. In addition, near misses are known to be important predictors of accidents, but they have been under-investigated in the agricultural sector in general and as concerns falls in particular. Method A questionnaire assessing dismounting behaviors, previous accidents and near misses, and participants' relation with work was administered to a sample of Italian tractor operators ( n = 286). Results A mediated model showed that worked hours increase unsafe behaviors, whereas work experience decreases them. Unsafe behaviors in turn show a positive association with accidents, via the mediation of near misses. Conclusions We gave a novel contribution to the knowledge of the chain of events leading to fall accidents in the agricultural sector, which is one of the most hazardous industries. Applications Besides tractor design improvements, preventive training interventions may focus on the redesign of the actual working strategies and the adoption of engaging training methods in the use of machinery to optimize the learning of safety practices and safe behaviors.

Objectives: We aimed at testing a model of the direct and indirect effects of being a part-time farmer on the probability of being involved in an agricultural machinery-related accident, considering the role played by unsafe beliefs and the frequency of use of machinery., Methods: Two-hundred and fifty-two Italian men, regular users of agricultural machinery (age: Mean = 45.1 years, standard Deviation = 17.5), were administered a paper-and-pencil questionnaire addressing their relation with work, unsafe beliefs, and previous experience of machinery-related accidents., Results: Being a part-time farmer showed a positive association with unsafe beliefs only among occasional machinery users. Unsafe beliefs in turn showed a positive association with accidents., Conclusions: The study gave a novel contribution to the knowledge of the chain of events connecting part-time farmers with machinery-related accidents. Preventive training interventions targeting part-timer farmers using agricultural machinery just occasionally should be developed.

Objectives: To perform an ergonomic analysis of work and machinery-related risks in a group of Swedish older farmers, investigating farmers' attitudes and perceptions about: 1) health status and work motivation, 2) physical and cognitive workload and difficulties in the interaction with machinery and technological innovations, and 3) risks and safety practices., Methods: Nine Swedish male farmers aged 65+ were administered a semi-structured interview and a questionnaire., Results: Participants perceived themselves as being in good health and considered farming as a good proxy of their health status. They reported an increased physical workload but did not describe any cognitive workload. Technology was reported to have low usability, and thus its benefits cannot be fully exploited. Older farmers acknowledged the existence of "new risks" related to the aging process and mainly referred to the common sense and previous experience as the best safety practices., Conclusion: Multilevel interventions focused on the capabilities and limits of the older farmers should be developed, involving both training activities and design solutions for the machinery that can support older farmers' health and safety.

Every year more than 2 million tons of citric acid (CA) are produced around the world for industrial uses. Although initially extracted from citrus, the low profitability of the process and the increasing demand soon stimulated the search for more efficient methods to produce CA. Currently, most world CA demand (99%) is satisfied by fermentations with microorganisms, especially filamentous fungi and yeasts. CA production with yeasts has certain advantages over molds (e.g. higher productivity and easier cultivation), which in the last two decades have triggered a clear increase in publications and patents devoted to the use of yeasts in this field. Yarrowia lipolytica has become a model yeast that proved to be successful in different production systems. Considering the current interest evidenced in the literature, the most significant information on CA production using Y. lipolytica is summarized. The relevance on CA yields of key factors such as strains, media formulation, environmental conditions and production regimes is thoroughly discussed, with particular focus on increasing CA productivity. Besides, the possibility of tuning the mentioned variables to reduce concomitant isocitric acid production-the biggest disadvantage of using yeasts-is analyzed. Available methods for CA purification/quantification are also discussed., (© FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Agricultural and earth-moving machinery operators are particularly exposed to whole-body vibration (WBV), which has severe effects on health and affects comfort and performance. Few studies have investigated vibrational safety and comfort issues in telescopic handlers. These vehicles are widespread in many off-road applications-such as construction, agriculture, and mining-used to handle loads and to lift persons and equipment. This study investigated the effects of an active hydro-pneumatic cab-suspension system fitted to a telehandler on a driver's vibration exposure along the x-, y-, and z-axes, through both objective and subjective assessments. Sixteen healthy professional telehandler drivers took part in the study. Objective measurements were acquired at the operator's seat, and subjective ratings were taken while participants drove the telehandler with either a deactivated or activated suspension system at 12 kph on an ISO 5008 smooth track. The results showed that the activation of the cab-suspension system reduced the root-mean-square acceleration along the x- and z-axes (p =.038 and p =.000, respectively). Moreover, the frequency analysis showed a reduction in the acceleration along the z-axis in the range of 2-25 Hz (p <.05 for all comparisons); in particular, the acceleration was reduced by 50% in the higher frequency range (4-20 Hz). A reduction in the vibration intensity was perceived by the participants along the y- and z-axes (p =.009 and p =.003, respectively). Implications for the future development of suspension systems are discussed.

Agriculture is among the most hazardous productive sectors, and farm machinery is a major source of injury. In the present study, a mediated model was used to test the role played by workers' characteristics, work environment factors, and near misses in predicting agricultural machinery-related accidents in a sample of Italian users (n = 290). Hours worked per week (via the mediation of an adverse work environment) showed a positive association and years of work experience (via the mediation of risk perception) showed a negative association with the probability of being involved in a near miss, which in turn showed a positive association with the probability of being involved in a machinery-related accident. Implications for tailored preventive interventions are discussed.

This study investigated the extent to which a sample of Italian users comprehended safety pictorials used on agricultural machinery. A questionnaire with 12 safety pictorials was administered to 248 users of agricultural machinery. For each of the pictorials, the participants were asked to select the most appropriate description of four written choices. The investigated safety pictorials were, in general, not well comprehended. Two different classes of participants were identified, each with a different level of comprehension. The participants with better comprehension were characterized by the regular use of agricultural machinery and frequent previous exposure to pictorials. The need for training courses focusing on safety pictorials and their meanings, as well as the need for improvement to the pictorials themselves to make them more easily comprehended, is discussed., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Hospital readmissions are common and costly and, in some cases, may be related to problems with care processes. We sought to reduce readmissions after percutaneous coronary intervention (PCI) in a large tertiary care facility through programs to target vulnerabilities predischarge, after discharge, and during re-presentation to the emergency department. During initial hospitalization, we assessed patients' readmission risk with a validated risk score and used a discharge checklist to ensure access to appropriate medications and close follow-up for high-risk patients. We also developed patient education videos about chest discomfort and heart failure. After discharge, we established a new follow-up clinic with cardiology fellows. A computerized system was developed to automatically notify cardiologists when patients presented to the emergency department within 30 days of PCI to enhance patient access to cardiology care in the emergency department. Early cardiologist assessment and assistance with triage was encouraged, and the emergency department used a risk stratification algorithm derived from a local database of patients to triage patients presenting with chest discomfort after PCI. We tracked the number of patients readmitted after PCI to our hospital. With our interventions, from 2011 to 2015, the index hospital readmission rate has declined from 9.6% to 5.3%. This program could provide tangible structural changes that can be implemented in other healthcare centers, both reducing the cost of care and improving the quality of care for patients with PCI., (© 2016 American Heart Association, Inc.)

Background: A lack of clarity exists about the role of complete coronary revascularization in patients presenting with non-ST-segment elevation myocardial infarction., Objectives: The aim of our study was to compare long-term outcomes in terms of major adverse cardiovascular and cerebrovascular events of 2 different complete coronary revascularization strategies in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease: 1-stage percutaneous coronary intervention (1S-PCI) during the index procedure versus multistage percutaneous coronary intervention (MS-PCI) complete coronary revascularization during the index hospitalization., Methods: In the SMILE (Impact of Different Treatment in Multivessel Non ST Elevation Myocardial Infarction Patients: One Stage Versus Multistaged Percutaneous Coronary Intervention) trial, 584 patients were randomly assigned in a 1:1 manner to 1S-PCI or MS-PCI. The primary study endpoint was the incidence of major adverse cardiovascular and cerebrovascular events, which were defined as cardiac death, death, reinfarction, rehospitalization for unstable angina, repeat coronary revascularization (target vessel revascularization), and stroke at 1 year., Results: The occurrence of the primary endpoint was significantly lower in the 1-stage group (1S-PCI: n = 36 [13.63%] vs. MS-PCI: n = 61 [23.19%]; hazard ratio [HR]: 0.549 [95% confidence interval (CI): 0.363 to 0.828]; p = 0.004). The 1-year rate of target vessel revascularization was significantly higher in the MS-PCI group (1S-PCI: n = 22 [8.33%] vs. MS-PCI: n = 40 [15.20%]; HR: 0.522 [95% CI: 0.310 to 0.878]; p = 0.01; p log-rank = 0.013). When the analyses were limited to cardiac death (1S-PCI: n = 9 [3.41%] vs. MS-PCI: n = 14 [5.32%]; HR: 0.624 [95% CI: 0.270 to 1.441]; p = 0.27) and myocardial infarction (1S-PCI: n = 7 [2.65%] vs. MS-PCI: n = 10 [3.80%]; HR: 0.678 [95% CI: 0.156 to 2.657]; p = 0.46), no significant differences were observed between groups., Conclusions: In multivessel non-ST-segment elevation myocardial infarction patients, complete 1-stage coronary revascularization is superior to multistage PCI in terms of major adverse cardiovascular and cerebrovascular events. (Impact of Different Treatment in Multivessel Non ST Elevation Myocardial Infarction [NSTEMI], Patients: One Stage Versus Multistaged Percutaneous Coronary Intervention [PCI] [SMILE]: NCT01478984)., (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Therapy with dual antiplatelet agents, defined as the combination of a platelet P2Y12 inhibitor and aspirin, is required to prevent thrombotic complications, after percutaneous coronary intervention (PCI) with stent implantation. Usually current guidelines recommend administration of dual antiplatelet therapy (DAPT) following percutaneous revascularization with drug-eluting stent (DES) for a period of at least 12 months or for 6 to 12 months in patients not at high risk. Nevertheless, the treatment of stable/unstable coronary artery disease with DES implantation increasing largely, the optimal duration of DAPT is still unclear. The duration of DAPT after coronary stenting has been evaluated in recent randomized studies with conflicting results. The administration of long period of DAPT is a strategy to reduce thrombosis events but largely increase the hemorrhagic ones. Otherwise, shorter DAPT period is protective about bleeds with consequently increased ischemic events. In addition, as new DES carry a lower risk of stent thrombosis (ST) compared with the first-generation DES and possibly even bare-metal stents, a shift toward better protection from ST may have an effect on the duration and the intensity of DAPT. Whether the duration of DAPT should be shorter or longer than the currently recommended 6 to 12 months is analyzed in this review, drawing on results from the most recent studies and meta-analysis.

Introduction: Pictograms affixed to agricultural machinery are important tools to reduce the occurrence of accidents and injuries when correctly noticed, comprehended, and followed. This study investigated the knowledge of safety pictograms used in agricultural machinery in a sample of farmers and farm workers and examined the factors influencing their comprehension., Method: A questionnaire with 12 safety pictograms used for agricultural machinery was administered to 281 owners or users of agricultural machinery. For each of the pictograms, the participants had to select the most appropriate verbal description from among four choices., Results: The pictograms examined yielded poor comprehension scores, including warnings related to the most frequent accidents involving agricultural machinery. Familiarity with the pictograms and years of experience with agricultural machinery significantly increased users' comprehension of the meaning of the pictograms., Conclusions: Specific training programs should be designed to draw attention to safety pictograms and to instill their meaning., (Copyright © 2015 Elsevier Ltd and National Safety Council. All rights reserved.)

Background: All-terrain vehicles (ATVs) are unstable on steep and rough terrain, and thus, rollover is the most common accident which can result in a high rate of fatal outcomes, with higher rates for young and male drivers., Objective: This paper investigates the ability of rural Pennsylvania ATV drivers to correctly evaluate slopes, and the mean slope angle at which the most and least conservative drivers indicate a beginning of concern of a roll-over., Method: The study was conducted using a simulator, a commercial ATV firmly fixed on an hydraulically-lifted platform. As the platform was being raised, participants were asked to report when they became uncomfortable and then when they would not drive across a slope at such an angle. The difference between the reported and the actual angles in both conditions were analyzed., Results: Fifty-five individuals, mostly male and younger than 20 years, participated in riding on the simulator. Between 1/3 and 1/4 of the participants correctly estimated the angle while approximately 2/3 of participants overestimated the angles at which they felt they would be uncomfortable and they would not drive across. Participants began to feel uncomfortable at 15.9±5.7 degrees and became so uncomfortable that they felt they would not drive at 22.7±3.7 degrees., Conclusions: Overestimation of lateral roll angles is the most common result. This is in favor of safety when drivers are informed about a slope limit ATVs should not be operated on.

A tractor stability simulator has been developed to help study tractor operators' perceptions of angles when the simulator is tilted to the side. The simulator is a trailer-mounted tractor cab equipped with hydraulic lift that can tilt the tractor cabin up to 30 degrees. This paper summarizes data from 82 participants who sat in the simulator while it was tilted. Demographic variables, estimates of tilt angles, and measured tilt angles were collected. The effects of age, gender, tractor driving experience, and frequency of operation on the estimated and measured tilt angles were analyzed. The results showed that about 50% of the participants reported estimations of side tilt angles within ±5 degrees of the actual angles, and nearly the same percentage overestimated the actual side tilt angles. Only a small percentage underestimated the angles. Older, more experienced, and male participants set higher limits on the actual angle at which they felt uncomfortable and would not drive.

Teleoperation has been widely applied in modern industry because of a variety of advantages, such as providing replaceable surrogates for humans in dangerous or difficult working environments over long distances. In this paper, a usability evaluation study of a teleoperation system for a compost spreader robotic machine is presented. The machine has been designed for the application of compost in small and stepping parcels of hilly vineyards. Driving and working tasks can be controlled remotely by a portable piloting unit, reducing the risk for the operator in the event of machine overturning. Participants of the study were asked to perform a series of tasks and sub-tasks and to vocalize their thoughts while working with the machine. The tasks were designed to simulate typical user experience. Once all the tasks were accomplished each participant was asked to fill a questionnaire. The evaluation considered aspects such as learnability, ease of use, understandability, controllability, frustration, mental effort, distraction, clarity of presentation, perceived usefulness, temporal efficiency and machine aesthetic. Results show that usability evaluation helped detecting design deficiencies in the teleoperated compost spreader machine.

Background: Current clinical practice in many emergency departments (EDs) includes checking a type and screen blood test (T&S) for Rhesus (Rh) status on all pregnant patients presenting with vaginal bleeding or abdominal pain. The test is expensive, and awaiting results may delay disposition., Objective: To determine if there is a subset of pregnant women who reliably know their blood type and for whom a T&S blood test to determine Rh status can be safely omitted or deferred., Methods: A prospective study at two associated urban academic centers with an annual ED census of 150,000 patients was performed between January 2007 and June 2008. Pregnant patients who had a T&S obtained as part of their ED evaluation were enrolled. Subjects completed a standardized data form that requested demographic information and were asked to select "no," "maybe," or "yes, definitely" if they knew their blood type. Standard descriptive statistics with 95% confidence intervals were performed., Results: There were 319 pregnant women enrolled in the study. Among the 106 subjects that reported "yes, definitely" they knew their blood type, 103 (97.2%; 95% confidence interval [CI] 94.0-100%]) identified their correct blood type and 105 (99.1%; 95% CI 97.2-100%) identified their correct Rh status. None of these subjects selected a positive Rh when they were in fact a negative Rh. All 14 (13.2%) subjects with a negative Rh status identified themselves as having a negative Rh., Conclusion: Pregnant women reporting that "yes, definitely" they know their blood type, are reliable. Deferring T&S testing test may be reasonable., (Copyright © 2011 Elsevier Inc. All rights reserved.)

ASL TO4-ICU inpatients with hip fracture over 5 month-period were 45, 12 men and 33 women, average age 81. In 42 patients the fall was accidental or environment-related, and in 40 cases it occurred at home. More than 3 coexisting diseases were found in 22 patients (48%), and polipharmacotherapy with more than 3 drugs in 27 (60%). Only 4 (8%) patients presented a diagnosis of osteoporosis, and only one treated with antiosteoporotic drugs. Before the fracture occurred, 35 (77%) subjects walked without help; 28 (62%) were functionally independent, 17 (38%) dependent; cognitive impairment was diagnosed in 11 (24%) patients. Side-fracture was intracapsular in 17 (38%), extracapsular in 28 (62%). Surgery treatment was osteosinthesys in 26 (58%), endoprosthesis in 11 (24%), total hip prosthesis in 8 (18%). Surgery-timing was of 3 or more days in 23 (51%) patients. In the elderly osteoporosis is underdiagnosed and undertreated, and surgery of hip fracture is always delayed.

Epidemiological data of pain prevalence, with particular attention to hospitalised subjects, are described as well as the problems of pain detection, its evaluation and management in older patients. The authors underline that chronic pain is the most frequent type of pain in advanced age, and it is often unrecognized and undertreated. Advanced age is not a sufficient reason to exclude an analgesic treatment which could improve the quality of life of these subjects. Elderly persons are at increased risk for adverse drug reactions, on the other hand, there is evidence that an appropriate use of analgesic drugs can provide significant relief and result in functional restoration, with a low risk of serious adverse effects. In the medical literature there are strategies and guidelines ad hoc. In Italy, since 2001 there is a plan drawn up by the Department of Health containing indications to fight against pain in hospital, but the adhesion of a number of hospitals to this plan seems to be not optimal.

Cytokines, which have been demonstrated in synovial fluids during various joint diseases, play an important role in mediating synovial inflammation and in regulating the immune response of many inflammatory processes. We studied synovial fluid, serum, and synovial fragments obtained from 33 patients--10 affected by serious gonarthrosis re-quiring a prosthetic implant, 8 with knee prosthesis aseptic loosening, and (as controls) 15 affected by degenerative meniscopathies--to evaluate the degree of inflammation and level of interleukins (IL-2, IL-4, IL-6, IL-10) and interferon gamma secretion. Histological analysis revealed slightly more infiltration by inflammatory cells in the synovial tissue of patients with gonarthrosis and knee prosthesis aseptic loosening than in that of the control group, with a high prevalence of macrophages. Moreover, we observed enhanced production of the studied cytokines, especially in synovial fluid as compared to serum, indicating that in the pathological conditions examined the inflammatory events are mainly localized. Because the role of these cytokines is to modulate inflammation, better knowledge of the involvement of cells and their soluble mediators in articular damage could guide immunomodulating treatment., (The Japanese Orthopaedic Association)