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Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

The melibiose permease of Salmonella typhimurium (MelBSt) catalyzes the stoichiometric symport of galactopyranoside with a cation (H+, Li+, or Na+) and is a prototype for Na+-coupled major facilitator superfamily (MFS) transporters presenting from bacteria to mammals. X-ray crystal structures of MelBSt have revealed the molecular recognition mechanism for sugar binding; however, understanding of the cation site and symport mechanism is still vague. To further investigate the transport mechanism and conformational dynamics of MelBSt, we generated a complete single-Cys library containing 476 unique mutants by placing a Cys at each position on a functional Cys-less background. Surprisingly, 105 mutants (22%) exhibit poor transport activities (

Purpose: We compare bipolar vs monopolar transurethral prostate resection safety/secondary outcomes including efficacy in patients with large prostate volume or severe lower urinary tract symptoms. Materials and Methods: From July 2006 to June 2009 candidates for transurethral prostate resection were recruited at 4 centers, randomized 1: 1 into monopolar/bipolar transurethral prostate resection arms and followed up to 36 months. Post hoc data analysis from patients with large prostate volume or severe lower urinary tract symptoms is presented. Patients with large prostate volume or severe lower urinary tract symptoms were defined as those with transrectal ultrasound based prostate volume greater than 80 ml or International Prostate Symptom Score greater than 19. Safety was estimated using sodium/hemoglobin changes immediately after surgery, complications during the early postoperative period (up to 6 weeks), and short-term (up to 12 months) and midterm (up to 36 months) followup. Secondary outcomes included, among others, efficacy quantified by changes in maximum urine flow rate, post-void residual urine volume and International Prostate Symptom Score compared with baseline. Results: A total of 279 patients were randomized. Post hoc analysis of data from patients with a large prostate volume or severe lower urinary tract symptoms was based on analysis A-in 62 of 279 participants (22.3%) (monopolar transurethral prostate resection 32, bipolar transurethral prostate resection 30) or analysis B-in 126 of 279 participants (45.2%) (monopolar transurethral prostate resection 57, bipolar transurethral prostate resection 69). Mean (SD) prostate volume was 108.0 (25.9) ml for monopolar transurethral prostate resection and 108.9 (23.4) ml for bipolar transurethral prostate resection (p = 0.756). Mean International Prostate Symptom Score was 25.0 (4.2) for monopolar transurethral prostate resection and 25.3 (3.7) for bipolar transurethral prostate resection (p = 0.402). Neither safety nor any secondary outcome differed significantly between the arms throughout followup. The only exception was the decrease in sodium (analysis A), which was significantly greater after monopolar transurethral prostate resection (-4.2 vs -0.7 mmol/l, p = 0.023) and did not translate into a significant difference in transurethral resection syndrome rates (monopolar transurethral prostate resection 1 of 32 vs bipolar transurethral prostate resection 0 of 30, p = 1.000). Conclusions: Bipolar and monopolar transurethral prostate resection show similar safety/efficacy in these patient subpopulations.

Cu and Zn have been shown to accumulate in the brains of Alzheimer's disease patients. We have previously reported that Cu(2+) and Zn(2+) bind amyloid beta (Abeta), explaining their enrichment in plaque pathology. Here we detail the stoichiometries and binding affinities of multiple cooperative Cu(2+)-binding sites on synthetic Abeta1-40 and Abeta1-42. We have developed a ligand displacement technique (competitive metal capture analysis) that uses metal-chelator complexes to evaluate metal ion binding to Abeta, a notoriously self-aggregating peptide. This analysis indicated that there is a very-high-affinity Cu(2+)-binding site on Abeta1-42 (log K(app) = 17.2) that mediates peptide precipitation and that the tendency of this peptide to self-aggregate in aqueous solutions is due to the presence of trace Cu(2+) contamination (customarily approximately 0.1 microM). In contrast, Abeta1-40 has much lower affinity for Cu(2+) at this site (estimated log K(app) = 10.3), explaining why this peptide is less self-aggregating. The greater Cu(2+)-binding affinity of Abeta1-42 compared with Abeta1-40 is associated with significantly diminished negative cooperativity. The role of trace metal contamination in inducing Abeta precipitation was confirmed by the demonstration that Abeta peptide (10 microM) remained soluble for 5 days only in the presence of high-affinity Cu(2+)-selective chelators.

Lo scopo di questo studio è quello di indagare e ripercorrere le tappe delle significative e progressive trasformazioni ed evoluzione del patrimonio botanico esistente nella Mostra d'Oltremare di Napoli. Con la "I Mostra Triennale delle Terre Italiane d'Oltremare", esposizione voluta dal governo fascista, per divulgare e mettere in "mostra" l'attività del lavoro italiano nelle colonie dell'Africa Orientale; tra il 1938 ed il 1940 si mise in atto una Kermesse progettuale, alla quale parteciparono noti professionisti del panorama nazionale e locale, che diede vita ad uno dei più significativi interventi architettonico urbanisto della Napoli del Novecento. Il parco fieristico della Mostra d'Oltremare, inaugurato il nove maggio del 1940 al cospetto di sua maestà il Re Imperatore Vittorio Emanuele III, sorto nella nuova zona di espansione occidentale della città, ambiva a diventare un fondamentale polo attrattivo per il mosaico paesistico culturale della città di Napoli, le scelte urbanistiche e quelle architettoniche attuate per tale realizzazione tennero conto di molteplici aspetti tra i quali anche quelli ambientali e paesaggistici. La progettazione esecutiva degli spazi verdi fu affidata agli architetti L. Piccinato (1899-1983) e C. Cocchia (1903-1993), che conferirono al verde progettato un'importante ruolo connettivo per l'intero impianto architettonico e urbanistico. I numerosi padiglioni espositivi risultarono immersi in suggestive aree verdi ricche di essenze esotiche, talvolta importate dalle terre d'origine, che riproponevano habitat e flora di ogni una delle colonie d'oltremare. Negli oltre 600.000 mq. destinati originariamente al complesso fieristico furono impiantate 30.000 piante d'alto fusto e circa un milione di piante arbustive ed erbacee. La massa principale del verde era costituita da una variegata e imponente raccolta di palme che conferirono all'ambiente un aspetto mediterraneo e tropicale, abbondanti anche gli esemplari di eucalipti, acacie, pini e magnolie. Il parco arboreo, una sorta di museo botanico a testimonianza del colonialismo italiano, dopo anni di abbandono e degrado dalla fine degli anni '90 grazie a buone pratiche di conservazione del verde, ha conservato esemplari botanici di pregio fino a i giorni nostri. Oggi appare fondamentale adoperarsi per la valorizzazione e conoscenza di quest'importante bene ambientale e culturale.

Fibroblasts are key cells in tissue repair and important contributors to the inflammatory response. Insulin-like growth factors (IGFs) have been shown to participate in growth, in immune responses and in tissue repair where they stimulate cell growth. Neurotensin (NT) has been suggested to participate in inflammation and in tissue repair and is an autocrine or paracrine growth factor for several cancer cell types. Here we show that IGF-induced proliferation of fibroblasts is enhanced by NT in a concentration and type 1 NT-receptor dependent manner. This action of NT was blocked by inhibitors of phospholipase C and protein kinase C but not by inhibitors of phosphoinositide-3-kinase. An inhibitor of MEK 1/2 significantly reduced the proliferative effects of the IGFs but NT's ability to enhance IGF-induced proliferation was not effected. The ability of NT to enhance IGF-induced proliferation did not involve an autocrine factor. These results suggest that interactions between NT and the IGFs may contribute to the regulation of fibroblasts in for example, inflamed or injured tissues.

Oxidative stress markers characterize the neuropathology both of Alzheimer's disease and of amyloid-bearing transgenic mice. The neurotoxicity of amyloid A beta peptides has been linked to peroxide generation in cell cultures by an unknown mechanism. We now show that human A beta directly produces hydrogen peroxide (H2O2) by a mechanism that involves the reduction of metal ions, Fe(III) or Cu(II), setting up conditions for Fenton-type chemistry. Spectrophotometric experiments establish that the A beta peptide reduces Fe(III) and Cu(II) to Fe(II) and Cu(I), respectively. Spectrochemical techniques are used to show that molecular oxygen is then trapped by A beta and reduced to H2O2 in a reaction that is driven by substoichiometric amounts of Fe(II) or Cu(I). In the presence of Cu(II) or Fe(III), A beta produces a positive thiobarbituric-reactive substance (TBARS) assay, compatible with the generation of the hydroxyl radical (OH.). The amounts of both reduced metal and TBARS reactivity are greatest when generated by A beta 1-42A beta 1-40rat A beta 1-40, a chemical relationship that correlates with the participation of the native peptides in amyloid pathology. These findings indicate that the accumulation of A beta could be a direct source of oxidative stress in Alzheimer's disease.

A modulation-independent method of reducing NTSC (National Television System Committee) co-channel interference into ATV (advanced television) signals is described. The design utilizes tunable, parallel connected, narrow-bandwidth IIR (infinite impulse response) filters to isolate and cancel the major components of NTSC. The canceler has been fully simulated and tested against actual NTSC signals corrupting a 32 QAM (quadrature amplitude modulation) signal. The canceler, based on notch filtering the audio, chrominance, and luminance carrier components, can increase the probability of detection by a least 3 dB compared to the same demodulator without a canceler. The detection probability increases by 1 dB per each additional luminance sideband notch filter pair. >

Biological nitrogen removal via nitrite may represent a promising process for the optimization of nitrogen removal, in particular in the presence of a low biodegradable COD/TKN ratio. In the present study a lab-scale sequencing batch reactor (SBR) was monitored for approximately 2 years to evaluate the use of dissolved oxygen (DO), pH and oxidation-reduction potential (ORP) as monitoring parameters in order to optimize nitrogen removal via nitrite from leachate generated in old sanitary landfills. The SBR manifested a nitrification efficiency exceeding 99% whereas, due to the low biodegradability of the organic matter presents in the leachates, COD removal reached approximately 40% and the addition of external COD was required to accomplish denitrification process. Moreover, the results demonstrate that DO, pH and ORP are reliable parameters for use in the monitoring of nitritation and denitritation processes in SBRs treating landfill leachates. Through manual modification of the length of the SBR phases to achieve nitrogen removal via nitrite, the nitritation and denitritation processes were rendered unstable leading to the saving of 20% in addition of external COD, almost half the theoretically achievable value. Furthermore, the low dissolved oxygen concentration applied during the oxic phases in an attempt to increase the nitritation process would appear to cause the settling characteristics of the activated sludge to deteriorate.

Neurotensin has been shown to influence growth in a number of cancerous and non-cancerous cells and to enhance the proliferative effects of growth factors without itself inducing proliferation. Here we show that neurotensin potentiates the proliferative effects of insulin on IMR90 human fibroblasts in a concentration and neurotensin receptor type 1-dependent manner. This potentiating effect of neurotensin was blocked by inhibitors of phospholipase C and protein kinase C, was accompanied by an increase in the level of soluble inositol phosphates and did not involve an autocrine factor. These results show that neurotensin can enhance insulin-dependent proliferation of human fibroblasts and suggest a possible role for neurotensin in tissue growth and repair.

Abeta derived from amyloid plaques of Alzheimer's disease-affected brain contain several oxidative posttranslational modifications. In this study we have characterized the amino acid content of human amyloid-derived Abeta and compared it with that of human synthetic Abeta subjected to metal-catalyzed oxidation. Human amyloid derived Abeta has an increased content of arginine (46%) and glutamate/glutamine residues (28%), but a decreased content of histidine residues (-32%) as compared to the expected amino acid content. Incubation of synthetic human Abeta with Cu(II), but not Fe(III), in the presence of H2O2 similarly induced a decrease in histidine residues (-79%), but also a decrease in tyrosine residues (-28%). Our results suggest that histidine and tyrosine are most vulnerable to metal mediated oxidative attack, consistent with our earlier findings that Cu coordinated via histidine residues is redox competent. Our results suggest that the loss of histidine residues in human amyloid-derived Abeta may be a result of Cu oxidation, and that unidentified post-translational mechanisms operate to modify other amino acids of Abeta in vivo.

The kynurenine pathway catabolite 3-hydroxykynurenine (3HK) and redox-active metals such as copper and iron are implicated in cataractogenesis. Here we investigate the reaction of kynurenine pathway catabolites with copper and iron, as well as interactions with the major lenticular structural proteins, the alpha-crystallins. The o-aminophenol kynurenine catabolites 3HK and 3-hydroxyanthranilic acid (3HAA) reduced Cu(II)>Fe(III) to Cu(I) and Fe(II), respectively, whereas quinolinic acid and the nonphenolic kynurenine catabolites kynurenine and anthranilic acid did not reduce either metal. Both 3HK and 3HAA generated superoxide and hydrogen peroxide in a copper-dependent manner. In addition, 3HK and 3HAA fostered copper-dependent alpha-crystallin cross-linking. 3HK- or 3HAA-modifed alpha-crystallin showed enhanced redox activity in comparison to unmodified alpha-crystallin or ascorbate-modified alpha-crystallin. These data support the possibility that 3HK and 3HAA may be cofactors in the oxidative damage of proteins, such as alpha-crystallin, through interactions with redox-active metals and especially copper. These findings may have relevance for understanding cataractogenesis and other degenerative conditions in which the kynurenine pathway is activated.

Oxidative stress markers as well as high concentrations of copper are found in the vicinity of Abeta amyloid deposits in Alzheimer's disease. The neurotoxicity of Abeta in cell culture has been linked to H(2)O(2) generation by an unknown mechanism. We now report that Cu(II) markedly potentiates the neurotoxicity exhibited by Abeta in cell culture. The potentiation of toxicity is greatest for Abeta1-42Abeta1-40mouse/rat Abeta1-40, corresponding to their relative capacities to reduce Cu(II) to Cu(I), form H(2)O(2) in cell-free assays and to exhibit amyloid pathology. The copper complex of Abeta1-42 has a highly positive formal reduction potential ( approximately +500-550 mV versus Ag/AgCl) characteristic of strongly reducing cuproproteins. These findings suggest that certain redox active metal ions may be important in exacerbating and perhaps facilitating Abeta-mediated oxidative damage in Alzheimer's disease.

This paper shows that the introduction of a premium quality standard can have repercussions on the market structure, opening the possibility of predatory behavior. The predatory equilibrium exists independently of whether or not adjustment costs are present. Moreover, whenever predation is an equilibrium, it is selected by the risk dominance criteria.

Between 1987 and 1991, the authors made patch-tests on 1,427 patients, 389 male and 1,038 female, of mean age 36 years (6-70 years) and mostly suffering from eczema. The standard tests of Italian Group for Research into Contact Dermatitis and the Environment (GIRDCA) were used, following the best data of recent years. Nickel sulphate, thiomersal, "Fragrance mix", cobalt sulphate and potassium bichromate were the allergens varied with age: nickel and thiomersal were most frequently positive between 20 and 30 years. In contrast, the highest frequency of positivity to fragrance mix was seen between 40 and 60 years. Positivity to a simple allergen had a tendancy to reduce with age.

In this paper we study an oligopoly game with a differentiated product using a dynamic evolutionary approach. Firms are allowed to choose between quantity setting and price setting behavior. We find that, under both classical interaction structures, namely 'random mating' and 'paying the field'. Quantity setting behavior (i.e., 'Cournot' behavior), is selected as an asymptotically stable state for the dynamics.

Myocardial performance is diminished in persistent SVT and will lead to hydrops fetalis (HDF). This study sought to determine which methods of fetal echocardiography are best for evaluating treatment and outcome in these fetuses. Methods: Ten infants with HDF due to SVT were included in this study. No fetus has structural heart disease. Serial cardiovascular function was estimated from CC/TC ratio, left ventricular shortening fraction, tricuspid E and A velocities and E/A ratio, mitral E, A velocities and E/A ratio and Doppler flow patterns in the free loop of the umbilical cord, MCA, ductus arteriosus and ductus venosus (DV) as well as maximal velocities and time velocity integrals into the ascending aorta and main pulmonary artery. The Tei index was calculated as the sum of the isovolumetric contraction time (ICT) and the isovolumetric relaxation time (IRT) divided by the ejection time using the ‘‘clicks’’ method. These parameters were compared to age matched normal fetuses from our data base. Changes in the gross measurements of third space effusions were considered demonstrable of improvement of fetal cardiovascular status. Results: The most sensitive indicator of change in fetal function was the Tei index followed by CC/TC ratio. Tei index is the first cardiovascular parameter which gets normalised in these fetuses responding to the treatment. There was no significant change over time with E/A ratios, LV shortening fraction or peripheral arterial Doppler values. DV A wave reversal normalized with cessation of SVT with normal PI values. DV size went from greater than the 95% to normal with cessation of SVT. Conclusions: The Tei index easily performed from 14 weeks through term. It is a useful and likely the most sensitive method of evaluating global myocardial performance in followup of fetuses with HDF especially due to SVT.

The purpose of this experiment was to study the readability of dials at different distances when the visual angle subtended by the dials is held constant. Five dials, the sizes and markings of which were proportional to viewing distance, were tested at distances ranging from 14 to 224 in. Each of 20 subjects made 20 readings on each dial. Care was taken to select subjects with excellent uncorrected near and far visual acuity. A focus sign above each dial was used to hold accommodation time constant. Directions to the subject stressed accuracy. Response times, errors of estimation, and questionnaire data were recorded. The results show a significant effect of distance on readability: Dials located at distances greater than 28 inches were read faster than two smaller, closer dials. Although there are no significant differences among the errors made on the five dials, the error data are consistent with the time data.

il lavoro tratta della determinazione della struttura di mercato prendendo in considerazione recenti modelli di oligopolio. Principalmente si focalizza sulle competizioni tecnologiche e sulla differenziazione del prodotto.

This paper studies the optimal behavior of a monopolist in the presence of asymmetric information cencerning the characteristics of the good he produces.

Summarizing our survey on Dermatophagoides inhalation allergy observed during 1979 in our outpatient department (88 positive cases) we can point out the following: 1. Instead of prick testing with various mite species, it seems more useful to carry out the testing with only one mixture of various species. 2. The well-known summer decrease in the incidence of mite allergy was not fully confirmed in our series of patients (due perhaps to peculiar humidity and environmental parameters, Fig.1). 3. The microecologic prevention of further attacks of the rhinitis-asthma syndrome provoked by this mite proved as a whole more rewarding in our patients than the specific hyposensitization course, which is troublesome and time consuming. 4. Comparing prick tests and RIST (total serum IgE) in our patients, we found both procedures to be equally rewarding. It follows that prick tests are to be preferred as they are less expensive and less time consuming.