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Congenital changes related to Spina Bifida (SB) include congenital clubfoot (PTC), also known as equinovarus congenital clubfoot. Skin pressure ulcers represent a frequent complication associated with SB and PTC, determined by both sensitivity deficits and skeletal alterations of plantar support. This conditions can lead to the onset of frequent neurotrophic skin ulcers.72-year-old female patient suffering from spina bifida with congenital clubfoot condition, complicated by ulcerative lesion in the plantar region with fistula and infection (Proteus Mirabilis). An infectious disease evaluation with monitoring of the inflammatory-infectious hematochemical values and targeted antibiothic-therapy was performed. The patient performed a scintigraphic examination in order to exclude the osteomyelitis process. The dressing protocol set up was: Disinfection with disinfectant based on Poliesanide and Betaine, with the use of Nelaton 6 Fr catheter (and subsequent dressings with 18 G needle cannula), inside the fistulous channel. Subsequent abundant washing with 0.9% saline solution. Application of oily phyto-product Mix of Neem Oil and Hypericum Perforatum (1-Primary Wound Dressing), inoculating it with the catheter inside the medium and checking its leakage from both sides and cover with sterile gauze and bandage with cohesive bandage. After 4 weeks there was a reduction in the size of the fistula and the disappearance of serum-corpuscular secretions. At 7 weeks, complete re-epithelialization of the skin ulcerative lesion was observed.This case report refers to the conservative medical treatment of a complex case of non-healing pressure skin ulcer with distant fistulization. The main difficulty in managing this lesion was identifying the right dressing that could reach and spread within the fistulous channel, favoring the reduction of the inflammatory-infectious process. The dressing used, as it was in an oily formulation, therefore had the right characteristics as it was easy to inoculate. The oily mix of Neem and Hypericum Perforatum (1-Primary Wound Dressing) has in fact performed a prolonged antiseptic function while maintaining the right degree of local hydration, essential for the correct carrying out of the reparative processes.In undermined or fistulous ulcers, the use of oil-based dressings, such as the oily mix of Neem and Hypericum Perforatum (1-Primary Wound Dressing), can represent a valid local therapeutic choice.Congenital clubfoot, Neurotrophic skin ulcer, Wound Care.Tra le alterazioni congenite correlate alla Spina Bifida (SB) va annoverato il piede torto congenito (PTC), noto anche come piede torto congenito equinovarus. Le ulcere da pressione cutanee rappresentano una frequente complicanza associata a SB e PTC, determinata sia da deficit di sensibilità che da alterazioni scheletriche del supporto plantare. Queste condizioni possono portare all’insorgenza di frequenti ulcere cutanee neurotrofiche.paziente donna di 72 anni affetta da spina bifida con condizione congenita del piede torto, complicata da lesione ulcerosa nella regione plantare con fistola e infezione (Proteus Mirabilis). Nel tentativo di salvataggio d’arto, in prima istanza è stata eseguita una valutazione della malattia infettiva con monitoraggio dei valori ematochimici infiammatorio-infettivi e terapia antibiotica mirata. La paziente ha eseguito dunque esame scintigrafico che escludeva processo osteomielitico. Il protocollo di medicazione predisposto è stato: Disinfezione con disinfettante a base di Poliesanide e Betaina, con utilizzo di catetere Nelaton 6 Fr (e successive medicazioni con cannula ago 18 G), all’interno del canale fistoloso. Successivo lavaggio abbondante con soluzione fisiologica allo 0,9%. Applicazione del fitoprodotto oleoso Mix di Olio di Neem e Hypericum Perforatum (1-Primary Wound Dressing Spray), inoculandolo con il catetere all’interno del tramite fistoloso e verificandone la fuoriuscita da entrambi i lati, ricopriendo successivamente il piede con garza sterile e bendaggio con bendaggio coesivo. Dopo 4 settimane si osservava una riduzione delle dimensioni della fistola e la scomparsa delle secrezioni siero-corpuscolate. A 7 settimane è stata osservata una completa riepitelizzazione della lesione ulcerosa cutanea DISCUSSIONE: Questo Case Report si riferisce al trattamento medico conservativo di un caso complesso di ulcera cutanea non-healing da pressione con fistolizzazione a distanza. La principale difficoltà nella gestione di questa lesione è stata individuare la giusta medicazione che potesse raggiungere e diffondersi all’interno del canale fistoloso, favorendo la riduzione del processo infiammatorio-infettivo. La medicazione utilizzata, essendo in formulazione oleosa, aveva quindi le giuste caratteristiche in quanto facile da inoculare. La miscela oleosa di Neem e Hypericum Perforatum (1-Medicazione Primaria per Ferite) ha infatti svolto una prolungata funzione antisettica mantenendo il giusto grado di idratazione locale, fondamentale per il corretto svolgimento dei processi riparativi.Nelle ulcere sottominate o fistolose, l’uso di medicazioni a base oleosa, come la miscela oleosa di Neem e Hypericum perforatum (1-Medicazione per Ferita Primaria), può rappresentare, in casi selezionati, una valida scelta terapeutica locale.

The objective is to show variations in the number of non-tenured personnel (NTP) in a public health research centre (IRCCS) between 30th June 2016 and 31st December 2017. In this time interval, the issue of NTP was at the centre of governmental discussions.Data collection was performed from CVs and scientific publications of NTP working at the Fondazione IRCCS Istituto Nazionale dei Tumori (INT). We compared the characteristics of NTP entering or leaving INT and those of NTP who remained in the considered time interval.NTP in INT counted 465 members of staff at 30th June 2016 and 472 at 31st December 2017. 75% of these works in the research. 26% of NTP left INT and their position resulted entirely substituted by other NTP. NTP staff who left are mainly aged under 40 and show fewer publications than those who stayed. Newly acquired NTP are younger and show a fewer number of publications compared to the personnel who left.1 out of 4 NTP members of staff moved to a new job during a period in which the uncertain future of NTP research staff was under the spotlight. It appears that IRCCS are progressively being identified as suitable for hands-on, post university internships from which researchers would then choose to move, in search of a new job in public or private centres, with a consequent decline of IRCCS' role in health research.

Insulin resistance and type 2 diabetes are independent risk factors for cardiovascular diseases. Levels of C-peptide are increased in these patients and its role in the atherosclerosis progression was studied in vitro and in vivo over the past years. To evaluate the possible use of C-peptide as cardiovascular biomarkers, we designed an observational study in which we enrolled patients with mono- or poly-vascular atherosclerotic disease.We recruited 431 patients with stable atherosclerosis and performed a yearly follow-up to estimate the cardiovascular and total mortality and cardiovascular events.We performed a mean follow-up of 56 months on 268 patients. A multivariate Cox analysis showed that C-peptide significantly increased the risk of cardiovascular mortality [Hazard Ratio: 1.29 (95% confidence interval: 1.02-1.65, p0.03513)] after adjustment for age, sex, diabetes treatment, estimated glomerular filtration rate and known diabetes status. Furthermore, levels of C-peptide were significantly correlated with metabolic parameters and atherogenic factors.C-peptide was associated with cardiovascular mortality independently of known diabetes status in a cohort of patients with chronic atherosclerotic disease. Future studies using C-peptide into a reclassification approach might be undertaken to consider its potential as a cardiovascular disease biomarker.

Study objectives were to assess the efficacy, safety, and tolerability of AFQ056 in Parkinson's disease patients with levodopa-induced dyskinesia. Two randomized, double-blind, placebo-controlled, parallel-group, in-patient studies for Parkinson's disease patients with moderate to severe levodopa-induced dyskinesia (study 1) and severe levodopa-induced dyskinesia (study 2) on stable dopaminergic therapy were performed. Patients received 25-150 mg AFQ056 or placebo twice daily for 16 days (both studies). Study 2 included a 4-day down-titration. Primary outcomes were the Lang-Fahn Activities of Daily Living Dyskinesia Scale (study 1), the modified Abnormal Involuntary Movement Scale (study 2), and the Unified Parkinson's Disease Rating Scale-part III (both studies). Secondary outcomes included the Unified Parkinson's Disease Rating Scale-part IV items 32-33. The primary analysis was change from baseline to day 16 on all outcomes. Treatment differences were assessed. Fifteen patients were randomized to AFQ056 and 16 to placebo in study 1; 14 patients were randomized to each group in study 2. AFQ056-treated patients showed significant improvements in dyskinesias on day 16 versus placebo (eg, Lang-Fahn Activities of Daily Living Dyskinesia Scale, P = .021 [study 1]; modified Abnormal Involuntary Movement Scale, P = .032 [study 2]). No significant changes were seen from baseline on day 16 on the Unified Parkinson's Disease Rating Scale-part III in either study. Adverse events were reported in both studies, including dizziness. Serious adverse events (most commonly worsening of dyskinesias, apparently associated with stopping treatment) were reported by 4 AFQ056-treated patients in study 1, and 3 patients (2 AFQ056-treated patient and 1 in the placebo group) in study 2. AFQ056 showed a clinically relevant and significant antidyskinetic effect without changing the antiparkinsonian effects of dopaminergic therapy. © 2011 Movement Disorder Society.

The O subfamily of forkhead (FoxO) 1 is a pivotal element in the regulation of endothelial activation. Compartmentalization and activity of FoxO1 is regulated by post translational modifications, but the implication in endothelial dysfunction and atherosclerosis remain controversial. Our aim was to identify FoxO1 related metabolic signatures in endothelial cells.Using metabolomics in human umbilical endothelial cells (HUVECs) overexpressing the wild type FoxO1 (FoxO1-WT), the acetylation defective mutant (FoxO1-KR), the unphosphorylated nuclear localized mutant (FoxO1-ADA) and the Green Fluorescent Protein (GFP) control vector, we identify metabolic pathways differentially affected by the different FoxO1 localization and activity. Among metabolites, asymmetric dimethylarginine (ADMA) was increased in FoxO1-ADA compared with FoxO1-WT and FoxO1-KR infected cells (p0.01). ADMA was further investigated to identify the molecular mechanisms to explain its link to FoxO1. We found that unrestrained FoxO1 activity leads to increase of ADMA via downregulation of its degrading enzyme, dimethylaminohydrolase (DDAH) 1. In human subjects (n = 89) the FoxO1/DDAH1/ADMA pathway marks unstable atherosclerosis.Our results point to ADMA as a biomarker to track deregulated FoxO1 activity in vivo.

The chimney graft technique is gaining popularity as an alternative endovascular treatment for juxtarenal aneurysms not suitable for standard or fenestrated endovascular aneurysm repair (EVAR).1–6 Despite excellent technical success,1,3–6 limited data are available regarding the long-term effectiveness of the technique, particularly in terms of chimney stent occlusion. This complication may have catastrophic consequences and represents a challenge for any endovascular approach, requiring in most the cases an open surgical bypass to restore vessel patency. Donas et al.1 used open thrombectomy to treat a renal chimney graft thrombosis. We encountered a symptomatic acute thrombosis of a renal chimney stent-graft, which we successfully treated with endovascular thrombectomy using a recanalization device that, in a recent article in the JEVT, proved useful in treating acute popliteal thrombosis.7