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The reduction of nitrites in cooked meat products is becoming a topic of primary importance, both for manufacturers and for consumers. However, their complete or partial replacement with a single natural compound is a challenge, due to the multifunctional characteristics of nitrites. One possible approach is the use of natural antioxidants from Mediterranean vegetal sources, such as olives and their processing by-products, which are rich in phenolic compounds. In particular, olive mill wastewaters (OMWW) generated during virgin olive oil production contain the majority of hydrophilic phenols (mainly secoiridoids and its derivates, which are found exclusively in the Oleaceae family), which are known to have high antioxidant and antimicrobial activities. Thus, if phenols are extracted from OMWW and purified by suitable membrane technology, they can be used for the formulation of healthier cooked meat products, with a reduced content of nitrate salts. The aim of this study was to evaluate the effect of an extract rich in phenols (PE), obtained from OMWW, on the oxidative stability and sensory characteristics of steam-cooked and grilled würstels during storage. The steam cooked würstels were prepared with beef (50%), lean pork (20%) and lard (30%), ice (20%), salt (1.25%), ascorbic acid (0.02%), aromas (0.33%) and liquid smoke (0.05%). The ingredients were homogenized until complete emulsion and, the dough was then divided into four batches: Control (NO2 150 mg/kg) and 3 PE-enriched samples (W1, W2 and W3, with PE 200 mg/kg + NO2 35/150/0 mg/kg). The emulsion was bagged into a collagen bowel and cooked in a steam oven until 72°C. After cooling in the blast chiller, würstels were peeled, vacuum-packed, pasteurized at 75°C for 20 min and stored under alternating exposure to fluorescent light at 4±2°C for 30 days. Steam cooked würstels were sampled at fixed time periods (0, 15 and 30 days of storage) and frozen at -80°C. At the same sampling times, the same number of steam cooked würstels from each batch were grilled at 200°C for 3.30 min per side until 70°C was reached at core. After processing and grilling, about 60% of total phenols were retained in PE samples. Regarding primary lipid oxidation, peroxide value (PV) in the control sample tripled in 30 days, while in W1 and W3 samples the final PV were 74% and 71% lower, respectively. Furthermore, no significant effect of storage on the PV of PE samples was observed. The steam-cooked control sample showed an increase in both conjugated dienes and trienes during storage, while these parameters remained almost constant in ungrilled PE samples. After grilling, all samples showed the classical bell-shape behavior of primary oxidation products. Regarding secondary lipid oxidation, VOCS largely confirmed the role of PE in limiting the increase of C5 and C6 saturated aldehydes that derive from lipid oxidation, being up to 36% lower in PE samples than in the control after 30-day storage, and up to 25% lower after grilling. In addition, grilled samples had TBARs values that were about 2 times higher than those of steam-cooked würstels, confirming the pro-oxidant effect of grilling. However, TBARs in both steam-cooked and grilled control würstels were lower than those of the PE samples during storage. Regarding COPs and COR%, no significative differences were found between PE and control steam-cooked würstel samples. No taste anomalies were detected for all products, confirming their stability during chilled displaying. Samples were only discriminated by a grayer color, which is due to the addition of a lower quantity of NO2 in the formulation of PE samples. This study confirms that it is possible to produce healthier low-nitrate würstels with improved oxidative stability by using PE from OMWW, thus representing a good strategy to valorize by-products of the olive oil food chain and to promote industrial symbiosis.

With the Neocognitron network processing within the GPU/CUDA presented in this work, we can conclude that there was a significant increase on the processing performance of the Neocognitron face recognition, showing the feasibility of using this method. However the size of images used in the operation were small, 57 x 57, which allowed the full load of the structure of the network into the memory of the device where access is protected and high-speed, factors that may have influenced the results presented. In an attempt to draw a line between the comparative Neocognitron network processed in the GPU/CUDA and traditional architecture it was verified through the calculation of speed-up, a gap, since they won a super-linear speed-up Sp > p. This occurred by differences in architecture. Moreover a high performance was observed when compared the time of processing. Another conclusion on the implementation of this project is that this minimizes some existing common problems, when used other parallel computing environment, cluster that for example, you can quote: Synchronization: since the granularity of development within this device is not competing for shared memories (each thread has its point / area of memory) there is a need for loss of time for achieving a synchronization of processors; Network: if the whole process takes place within the same device there is the issue connection type and the speed of the entire GPU architecture; and Contention: there is no competition for resources by processors.

The aim of the present study was to compare the clinical efficacy of chlorhexidine and ozonised water in the oral hygiene maintenance of orthodontic patients.Study design: This is a prospective clinical study. Thirty patients with orthodontic brackets were selected at the Versilia General Hospital (Lido di Camaiore, Italy). Patients were randomly allocated to one of two groups: standard oral hygiene session followed by prescription of either chlorhexidine mouth-rinse or ozonated water. At each moment of the follow-up, the following parameters were recorded: pocket probing depth (PPD), full-mouth plaque index (FMPI), and full mouth bleeding score (FMBS).Sample size was computed according to previously published data. Significance level was set at 0.05 for all analyses, and non-parametric Wilcoxon signed rank test was used for comparisons.At baseline, mean PPD was 1.89 ± 0.13 mm for the control group and 1.95 ± 0.10 mm for the test group. Mean FMPI was 63.9 ± 16.5% and 68.7 ± 10.33% respectively. Mean FMBS was 31.5 ± 15.6% and 32.8 ± 8.85 respectively. One month after treatment (T2), both groups showed a significant improvement of FMPI and FMBS. Mean FMPI was 42.8 ± 14.3% and 24.3 ± 6.41% respectively. Mean FMBS was 19.5 ±12.6% and 4.70 ± 3.56% respectively. The test group treated with ozone exhibited a greater improvement of FMPI and FMBS.Ozone yielded better outcomes than chlorhexidine in the management of gingivitis in orthodontic patients. Ozone should be further investigated in longitudinal studies with larger samples.

So far, the investigation in cancer cell lines of the modulation of cancer growth and progression by oxysterols, in particular 27-hydroxycholesterol (27HC), has yielded controversial results. The primary aim of this study was the quantitative evaluation of possible changes in 27HC levels during the different steps of colorectal cancer (CRC) progression in humans. A consistent increase in this oxysterol in CRC mass compared to the tumor-adjacent tissue was indeed observed, but only in advanced stages of progression (TNM stage III), a phase in which cancer has spread to nearby sites. To investigate possible pro-tumor properties of 27HC, its effects were studied in vitro in differentiated CaCo-2 cells. Relatively high concentrations of this oxysterol markedly increased the release of pro-inflammatory interleukins 6 and 8, monocyte chemoattractant protein-1, vascular endothelial growth factor, as well as matrix metalloproteinases 2 and 9. The up-regulation of all these molecules, which are potentially able to favor cancer progression, appeared to be dependent upon a net stimulation of Akt signaling exerted by supra-physiological amounts of 27HC.

Introduction An extrafine pMDI formulation of the long-acting beta agonist formoterol fumarate (FF) was developed, and its efficacy and safety evaluated in a controlled clinical setting. Methods A double-blind, double-dummy, single dose, randomised, 4-way crossover, placebo controlled study was conducted to evaluate efficacy and safety of FF (6 µg) one puff or two puffs versus Foradil Aerolizer (FOR) 12 µg or placebo in moderate to severe asthmatic patients. Primary endpoint was 12 hour average FEV1. Secondary efficacy endpoints were onset and duration of action. Safety endpoints were vital signs, QTc, serum potassium and glucose. Results 53 asthmatic patients (mean age 34.4 years, 32 male and 21 female) were randomized and 52 were evaluable. Average FEV1 and peak FEV1 increased significantly after FF 6 and 12 µg, with a trend toward greater efficacy with the higher FF dose. Equivalence between FF 12 µg and FOR 12 µg was demonstrated. Median time to 15% onset was 10, 15 and 10 min for FF 12 µg, FF 6 µg and FOR, respectively confirming the rapid onset of action. Median time to 15% offset was 718, 480, 719 and 240 min for FF 12 µg, FF 6 µg, FOR and Placebo respectively suggesting that FF 12 µg provides an improved coverage of the 12 hour administration interval and demonstrating a marked dose-response. No clinically significant changes were observed for blood pressure and heart rate. Serum potassium and glucose remained within normal limits for the majority of subjects. QTcB was similar for all treatments and no values exceeded 470 m/sec. There were no serious adverse events. Frequency of treatment emergent adverse events was similar in the four treatments, with tremor the most common, as expected. Conclusions This study demonstrates that extrafine FF has similar efficacy and safety as compared to FOR. FF 12 µg shows a greater and more prolonged bronchodilation compared to FF 6 µg, and confirms a marked dose–response relation for FF. This has to be considered when assessing the most appropriate therapeutic dose of FF in asthmatics.

Notwithstanding market consumers and demands are deeply changed in the direction of higher service contents, tomato products have maintained their commercial aspects unchanged. The sector needs a product upgrading as already seen in other commercial segments such as, for example, fruit juices or dairy products industries where new food proposals are more coherent with the new market requests (new lifestyles, more service content and environmentally friendly). The current market standardization of traditional tomato products (cherry and sun dried tomatoes) since their birth packed in cans or in glass jars doesn’t allow anymore their discrimination and competition with international companies more interested in new concepts, such as wellness, convenience and new lifestyles much more “on the go”. There is a great interest towards products, which remind consumer’s concepts like health and naturalness. Among these, traditional tomato products represent a trendy product in their several industrial forms (natural, peeled, puree, sun dried in oil). The development of the whole industrial chain seems therefore necessary turn out to be moreover realistic on larger markets, as happened in the recent past years for similar products. The goal of this research is to update some critical aspects of industrial tomato chain: either consumer and technological oriented.

This article presents a unique application of tolerance near sets (TNS) for detecting solar flare events in solar images acquired using radio astronomy techniques. In radio astronomy (RA) applications, the interferometric array processing of data streams presents algorithmic and response time challenges as well as a high volume of data. The radio interferometer is an RA instrument composed of an array of antennas. Radio signals emitted by a celestial object are captured by the antennas and are subsequently processed in such a way that each pair of antennas produces correlated data. The overall correlated data is then accumulated and, after an integration period, the spectral image of the observed object is obtained. The process of deconvolution of the spectral image produces the desired spatial image of the celestial object. The proposed solar flare detection system is embedded in a computational platform framework suitable for dealing with huge volumes of data, based on a cluster of CPU-GPU pairs. The experimental results presented in the paper include comparison of the TNS-based algorithm (implemented as the SOL-FLARE system) with the K-means algorithm using significant samples of test images to validate the detection system. The performances of both systems are comparatively analyzed using Receiver Operating Characteristic (ROC) curves. The images used in the experiments were selected from a data repository produced by the Nobeyama Radioheliograph, in Japan, during the years 2004 up to 2013. The main contribution of the article is a novel approach to solar flare detection in a GPU-CUDA framework.

Background Video-assisted thoracoscopic extended thymectomy (VATET) is well established in the treatment of myasthenia gravis; however, patient selection remains controversial. Perioperative management protocol is lacking, and concerns regarding post-operative myasthenic crisis still remain. We performed a retrospective observational study evaluating the impact of the introduction of a protocol in the perioperative management of patients with myasthenia gravis who underwent VATET. Methods The perioperative management protocol was developed by a team of neurologists and anesthesiologists who reviewed the literature and their previous experience on myasthenia gravis patients. Respiratory, clinical, and neurological patient features were included in the protocol evaluation. A retrospective review of patients who underwent VATET before and after introduction to the protocol was finally performed. Results The medical records of 66 patients (pre-protocol group) and 44 patients (protocol group) were available for the study. In the pre-protocol group, 17 patients (26%) were admitted to intensive care unit (ICU) during the post-operative period, while three patients (6.8%) of the protocol group met the criteria for ICU post-operative admission. This resulted in a reduction of 73.5% of patients admitted to ICU (P = 0.023) and in an 80% (P = 0.002) reduction of the use neuromuscular blocking agents. Two post-operative myasthenic crises preceded by bulbar symptoms (1.8%) were identified in the pre-protocol group patients. Conclusions Although the application of our protocol results in a substantial reduction in the recovery of patients in the ICU and in hospital costs, there was no substantial difference in mortality and morbidity between patients admitted to the surgical ward or to ICU.

PurposeThe pharmaceutical industry faces significant challenges in the immediate future, including drug safety, intellectual property in emerging markets, industry image, and the overall effect of marketing. To remain effective, pharmaceutical executives must translate these challenges to the industry into solutions, find relationships between individual issues, and group these issues into larger themes. The purpose of this paper is to study the issues that senior industry executives perceive the pharmaceutical industry faces and how they can organize these issues into high‐impact “pressure points.”Design/methodology/approachUsing a modified approach to the Delphi technique, 70 senior pharmaceutical industry executives rated issues facing the pharmaceutical industry. Their responses were then examined using factor analysis.FindingsThe study concludes that concerns about the industry's future must be accompanied by a concerted effort to communicate and market the importance drugs play in improving and extending lives.Practical implicationsThese will influence political factors that effect new drug development.Originality/valueThe study develops a list of potential major issues facing the industry over the next three to five years.

An uninterruptible power supply (UPS) based on hydrogen technologies has been designed, manufactured and tested. The system consists of a proton exchange membrane fuel cell running on hydrogen and oxygen, a gas storage section and a water electrolyser for hydrogen and oxygen production. The UPS is of fail-safe design, completely silent and very reliable, thanks to the complete absence of moving parts. The prototype has an output of 5 kW for a maximum period of 5 h. A 3 kW advanced alkaline electrolyser produces 0.6 N m 3 / h hydrogen and 0.3 N m 3 / h oxygen at 1.5 MPa, which are stored in metal hydride tanks of 21 N m 3 H 2 capacity and a cylinder stack, respectively. Upon grid power interruption, the fuel cell takes up the load, with the help of a battery during the first minutes of operation. The results of the operation of this prototype are presented and discussed.

Summary A new method based on crossover electrophoresis with indirect immunofluorescence for the identification of soy protein in heated meat products is described. The procedure demonstrates specific precipitation reactions between the antisera and soy protein, even when these are present at concentrations of 2.5% in meat products heated to the level of commercial sterility (125°C x 25 min).

K-feldspar megacrysts (Kfm) are used to investigate the magmatic evolution of the 7Ma Monte Capanne (MC) monzogranite (Elba, Italy). Dissolution and regrowth of Kfm during magma mixing or mingling events produce indented resorption surfaces associated with high Ba contents. Diffusion calculations demonstrate that Kfm chemical zoning is primary. Core-to-rim variations in Ba, Rb, Sr, Li and P support magma mixing (i.e. high Ba and P and low Rb/ Sr at rims), but more complex variations require other mechanisms. In particular, we show that disequilibrium growth (related to variations in diffusion rates in the melt) may have occurred as a result of thermal disturbance following influx of mafic magma in the magma chamber. Initial 87 Sr/ 86 Sr ratios (ISr) (obtained by microdrilling) decrease from core to rim. Inner core analyses define a mixing trend extending towards a high ISr–Rb/Sr melt component, whereas the outer cores and rims display a more restricted range of ISr, but a larger range of Rb/Sr. Lower ISr at the rim of one megacryst suggests mixing with high-K calc-alkaline mantle-derived volcanics of similar age on Capraia. Trace element and isotopic profiles suggest (1) early megacryst growth in magmas contaminated by crust and refreshed by high ISr silicic melts (as seen in the inner cores) and (2) later recharge with mafic magmas (as seen in the outer cores) followed by (3) crystal fractionation, with possible interaction with hydrothermal fluids (as seen in the rim). The model is compatible with the field occurrence of mafic enclaves and xenoliths.

Sodium 3,4-diaminonaphthalene-1-sulfonate (CRA) is a compound, synthesised by our group from Congo Red (CR), that is active in preventing the pathological conversion of normal prion protein (PrP). As the precise mechanisms controlling the ways in which prions are distributed and infect the brain and other organs are not fully understood, studying the pharmacokinetics of drugs that are active against prions may clarify their targets and their means of inhibiting prion infection. This paper describes the pharmacokinetics of CRA in plasma, spleen and brain after single or repeated intraperitoneal or subcutaneous administration, as determined by means of specific and sensitive fluorimetric HPLC. A single intraperitoneal administration led to peak plasma CRA concentrations after 15 min, followed by biphasic decay with an apparent half-life of 4.3 h. After subcutaneous administration, Tmax was reached after 30 min, and was followed by a similar process of decay: Cmax and the AUC0-last were 25% those recorded after intraperitoneal administration. The mean peak concentrations and AUCs of CRA after a single intraperitoneal or subcutaneous administration in peripheral tissue (spleen) were similar to those observed in blood, whereas brain concentrations were about 2% those in plasma. After repeated intraperitoneal or subcutaneous doses, the Cmax values in plasma, brain and spleen were similar to those observed at the same times after a single dose. After repeated intraperitoneal doses, CRA was also found in the ventricular cerebrospinal fluid at concentrations of 1.8 + 0.2 μg mL−1, which is similar to, or slightly higher than, those found in brain. Brain concentrations may be sufficient to explain the activity of CRA on PrP reproduction in the CNS. However, peripheral involvement cannot be excluded because the effects of CRA are more pronounced after intraperitoneal than after intracerebral infection.

This study examined the 18-month postlaunch behavior of 3,646 US physicians to determine how prelaunch company prescribing loyalty affects subsequent prescribing levels???a new product's prescribing volume and the incremental prescribing volume of other drugs from the company launching the new product. Prelaunch company prescribing loyalty is particularly important for understanding first-in-class drugs, less so for new drugs in existing drug categories. This loyalty is also associated with an increased prescribing volume for other drugs from the pharmaceutical company, regardless of a physician's willingness to prescribe the newly launched drug from that company.

A plastic scintillating disc (NE102, 3 cm thick, 1 m diameter) has been designed for detecting charged pions in nuclear reactions at intermediate energy. A hole of 20 cm diameter was made in the middle of the disc in order to allow for the beam passage through the detector. The originality of the detector consists of the simultaneous use of four very compact central Photo Multiplier Tubes (PMT) and eight peripheral PMTs in order to retrieve the hitting point of a charged particle onto the disc surface with a space resolution of ±3 cm. The original method has been developed by using polar coordinates and only the Time-Of-Flight information (TOF) from three or four nearest PMTs, including at least one central PMT.

External and internal factors affect firms' diversification patterns. Two patterns of diversification are prevalent in many industries: domestic diversification through the pursuit of different products and international expansion. An earlier study reasonably predicted telecommunication firms' diversification patterns based on their expected growth and the regulatory environment they face. This study applies the framework from the earlier study to the pharmaceutical industry. The results correlate well with expected diversification patterns.

We have measured liver heme oxygenase, a heat shock protein known to be increased under conditions of oxidative stress, to obtain additional evidence for an oxidative stress mechanism in hepatic uroporphyria induced by hexachlorobenzene (HCB). We have studied heme oxygenase at different times during HCB treatment and in two strains of rats (Agus and Wistar strains), which are known to differ in their sensitivity to the porphyria-inducing properties of HCB, in order to ascertain whether the same time course and genetic differences known to exist for the induction of porphyria also apply to hepatic oxidative stress. HCB induced heme oxygenase and accumulation of porphyrins in the liver of rats of both strains; no significant difference was found between the two strains in the HCB-induced heme oxygenase activity. The increased activity of the enzyme was first detected during the early phases of treatment, when a modest increase in liver porphyrins was observed; heme oxygenase remained at induced levels for several weeks during HCB treatment, and was still raised when an increase in total liver iron content and the onset of marked porphyria were also found. In contrast to the effects of HCB, phenobarbitone sodium (given in the drinking water for up to 4 weeks) produced similar elevations of total liver cytochrome P450 as HCB, but did not stimulate heme oxygenase or increase the total liver content of either iron or porphyrins. These results are compatible with an oxidative stress mechanism in HCB-induced liver toxicity and porphyria, but also suggest the existence of successive stages in the induction of hepatic porphyria, with more than one mechanism contributing to the marked accumulation of uroporphyrin.

The antioxidant properties of silibin complexes, the water-soluble form silibin dihemisuccinate (SDH), and the lipid-soluble form, silibin phosphatidylcholine complex known as IdB 1016, were evaluated by studying their abilities to react with the superoxide radical anion (O2.−), and the hydroxyl radical (OH.). In addition, their effect on pulmonary and hepatic microsomal lipid peroxidation had been investigated. Superoxide radicals were generated by the PMS-NADH system and measured by their ability to reduce NBT. IC50 concentrations for the inhibition of the NBT reduction by SDH and IdB 1016 were found to be 25 μM and 316 μM respectively. Both silibin complexes had an inhibitory effect on xanthine oxidase activity. SDH reacted rapidly with OH. radicals at approximately diffusion controlled rate and the rate constant was found to be (K=8·2×109M−1 s−1); it appeared to chelate Fe2+ in solution. In hepatic microsomes, when lipid peroxidation was induced by Fe2+, SDH inhibited by 39·5 per cent and IdB 1016 by 19·5 per cent, whereas when lipid peroxidation was induced by CuOOH, IdB 1016 exerted a better protective effect than SDH (29·4 per cent and 19·4 per cent inhibition, respectively). In both microsomal systems lipid peroxidation proceeded through a thiol depletion mechanism which could be restored in the presence of silibin complexes. Low levels of lipid peroxidation in pulmonary microsomes point out the differences between in-vitro lipid peroxidation occurring in microsomes of different tissues. The results support the free radical scavenger and antioxidative properties of silibin when it is complexed with a suitable molecule to increase its bioavailabilty. © 1997 John Wiley & Sons, Ltd.

The strategy of all retroviral infections is based on establishing an equilibrium between virus replication and proviral latency in the infected host. The human immunodeficiency virus-type 1 (HIV-1), belonging to the subfamily of lentiviridae, adds an additional level of sophistication to this general rule by encoding two regulatory genes (tat and rev) and four accessory genes (nef, vif, vpr and vpu); HIV-2, structurally similar to HIV-1 but characterized by lower pathogenicity in vivo, encodes another accessory gene, vpx. The function of these accessory genes has become clear in recent years: they serve as countermeasures to host-cell restriction factors that prevent or curtail the capacity of HIV to productively infect its target cells (typically, CD4+ T lymphocytes, macrophages and dendritic cells). Some of the best characterized restriction factors for HIV-1 are Tripartite Motif-5α (TRIM5α), preventing infection of nonhuman primates, although not being effective in humans, and apolipoprotein B mRNA-editing, enzyme-catalytic, polypeptide-like 3G (APOBEC 3G), counteracted by the viral accessory protein Vif. In addition, several other molecules are under scrutiny for their mechanism of action and potential exploitation as novel anti-HIV agents. This review will summarize the recently emerging knowledge on these novel factors and their potential relevance for the discovery of new anti-HIV agents targeting not only the replicative, but also the latent state of HIV infection.

A proportion of HIV-infected individuals experience episodes of localized or systemic bacterial infections caused by Gram-negative bacteria. Many of the clinical side effects of these infections are associated with the production of proinflammatory cytokines, which are induced primarily by LPS, a constituent of the bacterial cell wall of Gram-negative bacteria. The present study examines the mechanisms involved in LPS-mediated induction of HIV expression in U1 cells, a promonocytic cell line chronically infected with HIV. Stimulation of U1 cells by LPS alone induced minimal levels of HIV expression, which was significantly enhanced by granulocyte-macrophage colony-stimulating factor (GM-CSF). Costimulation of U1 cells with LPS plus GM-CSF resulted in the accumulation of steady-state levels of HIV RNA; however, only a weak induction of HIV long terminal repeat-driven transcription, which was not associated with the activation of the cellular transcription factor nuclear factor-kappa B, was noted. Costimulation of cells with LPS plus GM-CSF induced the production of proinflammatory cytokines, IL-8, IL-1 beta and IL-6, but not TNF-alpha. IL-1 receptor antagonist (ra) inhibited LPS enhancement of HIV expression in GM-CSF-stimulated cells, suggesting that endogenous IL-1 was involved in LPS-mediated viral production. In this regard, anti-inflammatory cytokines inhibited LPS plus GM-CSF-stimulated HIV expression, and this effect closely correlated with inhibition of IL-1 beta release and, in particular, with up-regulation of endogenous IL-1ra production. Thus, the balance between an endogenously produced viral inducer (IL-1 beta ) and an inhibitor (IL-1ra) may represent an important pathway leading to modulation of HIV expression from monocytic cells.

Hepatocytes isolated from male Wistar rats of 2-3 and 20-24 months of age were compared as regards concentration and metabolism of 4-hydroxy-2-nonenal, one of the major aldehyde products of n-6 fatty acid oxidative breakdown. A significant accumulation of fluorescent 4-hydroxy-2-nonenal-membrane lipid adducts was found in the cells from the old rats. The mechanism mainly responsible for such aldehyde accumulation was shown to be the impairment of its enzymatic metabolism. In fact, while endogenous, that is non-stimulated, aldehyde production was not impaired, the reductive pathway of 4-hydroxy-2-nonenal metabolism in hepatocytes from old rats was strongly depressed. The decrease of 4-hydroxy-2-nonenal consumption with age was confirmed in homogenates from liver and kidney, while there were no differences between young and old animals in heart, lung or brain.

Background Video-assisted thoracoscopic extended thymectomy (VATET) is well established in the treatment of myasthenia gravis; however, patient selection remains controversial. Perioperative management protocol is lacking, and concerns regarding post-operative myasthenic crisis still remain. We performed a retrospective observational study evaluating the impact of the introduction of a protocol in the perioperative management of patients with myasthenia gravis who underwent VATET. Methods The perioperative management protocol was developed by a team of neurologists and anesthesiologists who reviewed the literature and their previous experience on myasthenia gravis patients. Respiratory, clinical, and neurological patient features were included in the protocol evaluation. A retrospective review of patients who underwent VATET before and after introduction to the protocol was finally performed. Results The medical records of 66 patients (pre-protocol group) and 44 patients (protocol group) were available for the study. In the pre-protocol group, 17 patients (26%) were admitted to intensive care unit (ICU) during the post-operative period, while three patients (6.8%) of the protocol group met the criteria for ICU post-operative admission. This resulted in a reduction of 73.5% of patients admitted to ICU (P = 0.023) and in an 80% (P = 0.002) reduction of the use neuromuscular blocking agents. Two post-operative myasthenic crises preceded by bulbar symptoms (1.8%) were identified in the pre-protocol group patients. Conclusions Although the application of our protocol results in a substantial reduction in the recovery of patients in the ICU and in hospital costs, there was no substantial difference in mortality and morbidity between patients admitted to the surgical ward or to ICU.