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This study determined the prevalence of fibrinous pericarditis and its correlation with other pluck lesions in 658 batches of pigs from 236 intensive farms located in Northern Italy over a 12-month period. All pigs were slaughtered at 170 kg, and a total 57,943 plucks (approximately 90 pigs/batch) were individually assessed for the presence of fibrinous pericarditis, pneumonia, pleuritis, and liver milk spots. There was no seasonal variation in the prevalence of plucks with fibrinous pericarditis and annual mean prevalence was 5.6% (range, 0-26.3% at batch level; median, 4.71%). Farm of origin, evaluated as a random effect, accounted for 17.7% batch variation. Batches with a high prevalence of fibrinous pericarditis (≥7.7%) had higher prevalences of pleural, pulmonary, and liver lesions than those with low-middle prevalence of pericarditis; high prevalence of pericarditis was predictive of pluck lesions (P0.001). There was a highly significant association between fibrinous pericarditis and severe pleuritis, and 55% of plucks with the highest score for pleuritis also had ongoing fibrinous pericarditis, with a positive correlation at batch level (r

Air cavities employed under ship hulls can result in significant decrease of the water frictional drag by reducing the hull wetted area. However, these cavities usually perform well only in a limited range of the ship speed and attitude. In off-design states and in the presence of sea waves, efficient air cavities covering large areas of the hull are difficult to form and maintain. This problem can be potentially addressed with help of hydrodynamic actuators, such as compact hydrofoils, tabs, and spoilers, which can assist with forming and maintaining air cavities under ship hulls. In this study, exploratory tests have been conducted with a simplistic small-scale hull having a bottom recess. Air was supplied into the recess to produce an air cavity, and several actuators were implemented and manually controlled during the tests. Subjected to external water flow, the air cavity under the hull was found to be responsive to variable positions of the actuators. Positive effects on the air cavity produced with specific actuator settings are identified and discussed in the paper. A series of experimental photographs of the air-water interface are shown for various actuator settings. The air flow rates needed to establish and maintain a large air cavity under the model hull are also reported.

Previous article in issueNext article in issue Introduction: There is a limited documentation about the retreatment of patients failing a recommended NS5A-containing regimen in Italy. Materials & methods: Within the VIRONET-C network, 386 NS5A-failing patients infected with different HCV-genotypes (GT) (GT1a/1b/2a-c/3a-b-g-h/4a-d-n-o-v=93/124/19/112/38) were analyzed. Retreatment of 105 failures was investigated. HCV-resistance-test was performed by Sanger-sequencing. Results: Failures following seven different NS5A-containing regimens were studied: 3D/2D (paritaprevir/ombitasvir ± dasabuvir) ± ribavirin (N = 72/4), daclatasvir/ledipasvir/velpatasvir + sofosbuvir ± ribavirin (N = 105/131/20), grazoprevir/elbasvir ± ribavirin (N = 34), glecaprevir/pibrentasvir (N = 20). Notably, 18.1% of NS5A-failing patients did not show any resistance-associated-substitutions (RAS), while 81.9% showed at least one NS5A-RAS, with multiclass-resistance in 35.5%. NS5A-RAS were observed more frequently in glecaprevir/pibrentasvir failures (GT1a 83.3%: Y93H + Q30H/D or +H58D; GT3a: 83.3% Y93H + A30K/G or +L31I) compared to sofosbuvir/velpatasvir (GT1a 16.6%: Y93H + Q30H, p = 0.08; GT3a 20.0%: Y93H/N + A30K/T, p = 0.03). To date, 105 failures have started a retreatment: sofosbuvir/velpatasvir ± ribavirin (N = 30), sofosbuvir/velpatasvir/voxilaprevir ± ribavirin (N = 67), glecaprevir/pibrentasvir (N = 4), grazoprevir/elbasvir ± sofosbuvir + ribavirin (N = 3), 3D + sofosbuvir + ribavirin (N = 1). The majority of patients were cirrhotic (51.9%) and relapsers (87.5%). The prevalence of NS5A-RASs before retreatment was 80.9%, with multiclass-resistance 29.5%. Among patients completing post-retreatment follow-up, a sustained-viral-response at week 12 (SVR12) was observed in 26/33 (78.8%). SVR4 was documented in 49/56 (87.5%). SVR12 was 76.0% with sofosbuvir/velpatasvir ± ribavirin (N = 25). Differently, SVR12 was 100% with glecaprevir/pibrentasvir for 8/12/16 weeks (N = 3), grazoprevir/elbasvir ± sofosbuvir + ribavirin for 12/24 weeks (N = 3) or 3D + sofosbuvir + ribavirin for 24 weeks (N = 1), despite the presence of NS5A-RASs. Until now, 67 patients started sofosbuvir/velpatasvir/voxilaprevir ± ribavirin recommended-retreatment for 12 weeks. 54/67 (80.6%) showed at least one baseline NS5A-RAS, 23/67 (34.3%) multiple-NS5A-RASs, and 22/67 (32.8%) multiclass-resistance. Of 25 patients with available outcome, 96.0% had SVR4. Only 1 GT1b infected patient was non-responder, without RASs before retreatment. Conclusions: In this real-life setting, NS5A-RASs were frequently detected at failure, and multiclass-resistance was around 30%. Overall, SVR after resistance-test-guided retreatment was >95%, with the exception of the sofosbuvir/velpatasvir retreatment. Our results show how HCV resistance-test at failure may be useful to optimize retreatment strategies.

There is a relative lack of confidence among GPs in the assessment and management of IBP vs. mechanical back pain. A simple screening tool for SpA, applicable in primary care urgently needs to be developed. It is reasonable for patients with symptoms suggestive of inflammatory back pain to be referred to secondary care without further investigations. The objective of this study was to assess current practice of our local general practitioners (GPs) in using clinical features, as well as radiological and laboratory investigations to assess patients with IBP. An online, observational questionnaire-based survey was done in 10 West Midlands CCGs including disparate geographical and socioeconomic areas. The survey consisted of 23 questions based on Calin, Berlin and ESSG Criteria for spondyloarthropathies. GPs were asked to rate the importance of a range of symptoms as indications of IBP IBP (10 point scale, range 1–10), and what their views were on which were the most important treatments for patients with suspected inflammatory back pain(4 point scale, range 1–4). The 4 most important symptoms for predicting inflammatory back pain according to our local cohort of GPs were ‘morning stiffness’ ‘sleep disturbances caused by back pain’ ‘insidious onset’ and ‘age of onset’

Various conservative treatments and surgical techniques have been reported in the literature as efficient and feasible measures to treat the cubital tunnel syndrome. However, there has been no consensus on the best management of the syndrome, and uniform standardised guidelines have not yet been accepted or introduced. With our study, we present our experience on the clinical efficacies and outcomes of the surgical techniques of neurolysis alone and neurolysis associated with ulnar nerve anterior transposition at the elbow joint in patients with neuropathic symptoms due to cubital tunnel syndrome.A total of 107 patients with cubital tunnel syndrome were retrospectively enrolled, surgically treated and followed up in our study. The cohort was divided into two groups: 41 patients treated only with neurolysis of the ulnar nerve (Group 1), and 66 patients treated with neurolysis and anterior transposition (Group 2). Of the participants, 35 were women and 72 were men. The average age was 54 years. Significant comorbidities were preoperatively diagnosed in 26 patients. Conservative measures had been considered, followed by surgical management if appropriate. A pre-op electromyography was performed for all patients. All surgical procedures were performed by the same surgical team. A post-operative follow-up was carried out, and the findings were recorded. The "McGowan" and "Wilson and Krout" classifications and the DASH score were used. A satisfaction questionnaire was administered to all patients post-operatively at 2 weeks).Ulnar nerve neurolysis and anterior transposition surgery were all successfully performed. Overall complications were post-operative haematoma (8%) and wound problems (5%). In 6% there was recurrence of symptoms. In 11% there was no improvement of symptoms. Pre-op McGowan classifications for groups 1 and 2 were 0% and 0% (grade 0), 21% and 24% (grade 1), 46% and 44% (grade 2), and 33% and 34% (grade 3), respectively. The post-op McGowan classifications were 34% and 37% (grade 0), 39% and 40% (grade 1), 23% and 20% (grade 2), and 4% and 3% (grade 3), respectively. The post-op Wilson and Krout classifications were 45% and 46% (excellent), 26% and 28% (good), 19% and 15% (fair), and 10% and 11% (poor), respectively. The DASH score means for groups 1 and 2 were 14.8 and 15.2, respectively. A negative Froment's sign was present in 73.2% and 71.2%, respectively. In Group 1, the post-op satisfaction questionnaire scores were 0 for one patient, 1 for four patients, 2 for seven patients, 3 for ten patients, 4 for twelve patients and 5 for seven patients. In Group 2, the post-op satisfaction questionnaire scores were 0 for three patients, 1 for nine patients, 2 for twelve patients, 3 for fifteen patients, 4 for eighteen patients and 5 for nine patients.In our experience, the surgical technique to treat the cubital tunnel syndrome most efficiently and feasibly has not yet been established in terms of indications and outcomes. This is supported by the data present in the international literature. Good and similar results were obtained with neurolysis alone and neurolysis associated with anterior transposition of the ulnar nerve (in line with the international data). In conclusion, more high-quality studies of greater statistical power are needed to provide a consensus on the surgical indications and techniques to treat the cubital tunnel syndrome and to establish internationally standardised guidelines.

This study examined the short- and long-term effects on the reproductive performance of sheep by subjecting them to varieties of subterranean clover (Trifolium subterraneum), containing a low content of total phytoestrogens and formononetin. In the first trial, 30 ewe lambs of the Sarda breed (initial mean live weight 16.4 ± 1.3 kg) were divided into three groups of 10 animals each and maintained separately on pastures for 60 d, with alfalfa (Medicago sativa L.), oats (Avena sativa), and subterranean clover with a phytoestrogen content ranging from 10.21 mg/g on a dry matter basis (DM) at the onset, to 0.90 mg/g DM at the end of the trial, respectively. All three pastures were integrated to make them isoproteic and isoenergetic. At the end of the grazing period, the animals were pooled into one group and fed the same phytoestrogen-free diet. No differences were recorded between the groups with regard to the development of the reproductive system as monitored by transvaginal ultrasonography, fertility, fecundity, breeding performance of the ewes, or with regard to the birth weight and conformation of the lambs. Puberty was attained earlier by the animals fed on subterranean clover, while the lambs also weighed more. In the second trial, 24 ewe lambs of the Comisana breed (initial mean live weight 25.0 ± 3.4 kg) were divided into two groups of 12 animals each. All animals were fed ad libitum for a 20 months period with fresh-cut or dried subterranean clover (phytoestrogen content of 0.88 and 0.81 mg/g DM, respectively); or a control non-estrogenic diet, based on fresh-cut or dried Italian ryegrass (Lolium multiflorum Lam.). The two diets were integrated so to be isoenergetic and isoproteic. No differences were recorded between the groups with regard to the attainment of puberty, although the animals fed clover were heavier at puberty. The development of the reproductive system, fertility, fecundity and breeding performance in both lambings, the interval between lambings, and body weight and conformation of the lambs did not show differences. In both trials, neither non-degraded phytoestrogens nor equol (metabolite of formononetin) were recorded in the blood of the ewes. The only metabolite present was p-ethylphenol. All animals fed subterranean clover-based diets, showed a significantly higher ADG, compared to those fed the control diets. The results of this study indicate that the levels of total phytoestrogens and formononetin in the new varieties of subterranean clover do not negatively affect the reproduction of sheep and appear to improve the growth rate of the animals.

PURPOSE Diabetic macular edema (DME) causes visual loss in diabetic patients. Multifocal electroretinograms (mfERGs) have been used to assess macular function pre- and postvitrectomy for DME. METHODS A standard three-port pars plana vitrectomy with peeling of inner limiting membrane was performed in 25 eyes of 21 patients (13 male, 8 female) with DME. For each patient, visual acuity examination, measure of retinal thickness (using optical coherence tomography), and mfERGs were performed before and 1 week, 1 month, 3 months, and 6 months after vitrectomy. RESULTS Mean postoperative visual acuity was significantly improved (p

The aim of the present study was to evaluate the effect of a prolonged administration of phytoestrogens on sheep growth rate, female reproductive response, lamb carcass conformation and meat quality. To investigate these effects, two groups of Comisana sheep (24 females and 20 males, initial average live weights of 25.0 and 29.9 kg, respectively) were fed on subterranean clover (SC, phytoestrogen content = 0.8 mg/g of DM) and Italian ryegrass (C, non-oestrogenic control diet) for about one year. Feedstuffs were offered ad libitum and supplemented with maize grain and sunflower meal to maintain an adequate and similar energy and protein intake. The results demonstrated that the prolonged administration of the selected subterranean clover cultivars, with low formononetin content (lower than 10% of total isoflavones on dry basis), did not affect ewe reproduction but induced a significant improvement in animal weigh gain and, in males, good carcass and meat characteristics.

The animal investigated was a two years old male control Sprague-Dawley rat which died spontaneously during a carcinogenicity study. Post-mortem examination disclosed hepatic and splenic enlargement. At microscopical examination, massive leucaemic infiltration was observed in many tissues/organs, including bone marrow, spleen, liver and renal blood vessels. A very unusual finding was observed in the lung, consisting of scattered micronodules which replaced most of the lung parenchyma. They contained collagen, displaying a somewhat circular distribution at the periphery of the lesions, fibrin, leukemic cells and fibroblasts. Immunostaining for desmin revealed the presence of smooth muscle fibers within the nodules, while staining for elastic fibers showed clearly that the internal and external elastic membranes were identifiable within the nodules. The diagnosis of pulmonary vascular sclerosis was made on the basis of microscopical and immunohistochemical findings.

Objective: To study significant factors associated with the risk of hypertension among obese women, with and without a history of weight cycling (WC). Design: Case–control study. Setting: Obesity Clinic of Chieti University, Italy. Subjects: A group of 258 obese women aged 25–64 y (103 cases with hypertension and 155 controls) were recruited. All obese subjects had the same clinical characteristics, were without a family history for hypertension, were non-smokers, had normal lipidemic profiles and normal glucose tolerance, were not taking any medication and were otherwise healthy. Intervention: In the weight cycling women, the history of WC was established on the basis of at least five weight losses in the previous 5 y due to dieting, with a weight loss of at least 4.5 kg per cycle. A logistic regression model adjusted for confounding variables such as waist-to-hip ratio (WHR) and weight cycling history parameters was used and the odds ratio (OR) with 95% confidence intervals was calculated. Results: The risk of hypertension increases in subjects with larger WHR (OR 7.8; 95% CI 3.4–17.9) and with a positive history for WC (OR 4.1; 95% CI 2.4–6.9). Further, in obese patients with WC, the weight cycling index and the sum of the weight regained are also important risk factors for hypertension. Conclusions: These findings could support the hypothesis that it is the combined exposure of central-type obesity and WC that strongly raises the risk of hypertension. Sponsorship: This work has been financially supported by a grant of Ministero dell’Universita e della Ricerca Scientifica e Tecnologica. European Journal of Clinical Nutrition (2000) 54, 356–360

The mononuclear rearrangement (MRH) of the Z-2,4-dinitrophenylhydrazone (4a) and of the Z-phenylhydrazone (4b) of 5-amino-3-benzoyl-1,2,4-oxadiazole into the relevant triazoles 5a and 5b in toluene has been quantitatively investigated in the presence of trichloroacetic acid (TCA) and of piperidine at 313.1 K. While the behavior in the presence of piperidine recalls the one previously evidenced for some Z-hydrazones of 3-benzoyl-5-phenyl-1,2,4-oxadiazole, the study of the reactivity in the presence of TCA has most interestingly evidenced a general-acid-catalyzed rearrangement for “both” 4a and 4b. Thus, 4a offers the first example of a solvent-dependent dichotomic behavior in MRH processes on 1,2,4-oxadiazole derivatives as far as it undergoes an “acidic hydrolysis” in dioxane/water and a “rearrangement” in toluene.

A search of the rat tumor literature revealed no papers on naturally occurring primary osteosarcoma of meninges. In humans, this tumor, arising primarily from the meninges, is unusual; only two cases have been reported. We report on a spontaneously occurring osteosarcoma arising from meninges in a 2-year-old female albino rat. The diagnosis was made on the basis of gross, microscopic, and ultrastructural findings. The diagnosis of this neoplasm is supported by the fact that a primitive mesenchymal cell in the meninges is capable of giving rise to a wide variety of neoplasms.

Internal Medicine lessons were integrated with simulation of clinical cases (Socrates program). The subsequent evaluation of 188 students was conducted with the Procustes program (Computer-Aided Assessment of Patient Problem: CAAPP). An increase in the number of training hours with the Socrates program results in improved examination performance. The data suggest that teaching with a learning program based on simulation of a clinical problem or cases may be a useful tool to integrate with traditional lessons. In addition, assessment with the Procustes program may support the appraisal of clinical knowledge and competence.

The manufacturing process of paperboard food packaging can produce small quantities of 3-chloro-1,2-propanediol (3-MCPD or 3-monochloropropane-1,2-diol) when wet-strength resins containing epichlorohydrin are used. 3-MCPD is from the same family as 1,3-dichloro-2-propanol (1,3-DCP), which is known to cause cancer in animals. 3-MCPD has been found in acid hydrolyzed vegetable protein, Asian sauces and paperboard for food contact. In this investigation, we conducted extraction studies to measure 3-MCPD migration into food simulant solvents from the food contact side of polyethylene extrusion-coated paperboard beverage cartons and aqueous extractions of cut pieces from the entire paperboard. We demonstrate that 3-MCPD confirmed present at concentrations up to 9.9 mg kg(-1) within the paperboard matrix does not migrate through the polyethylene-coated food contact surface. The aqueous extraction of the entire paperboard and food contact side extractions with aqueous/acidic food simulants were performed using US Food and Drug Administration (FDA) and European Commission (EU) migration testing protocols. We also show that no significant amount of 3-MCPD migrates through the unskived edges on the inside seam of the paperboard structure. The methodology for the aqueous and migration cell extractions using GC-MS analyses was validated with a limit of quantification (LOQ) of 0.009 mg kg(-1) and a limit of detection (LOD) of 0.005 mg kg(-1).

The aim of this study was to determine how different scoring methods could influence the results achieved in clinical competence assessment examinations at the end of the medical school curriculum. Fifty-six final-year medical school students were examined using a programme of multimedia computer-based simulated cases (Procuste programme). For generating results, the following scoring methods were applied: (1) the method used for the Internal Medicine official certification examination which includes both weighted and unweighted items; (2) a method with only unweighted items;(3) a method which includes single-item analysis. Each time an absolute pass/fail cut-off standard (#83 60/100) and a relative pass/fail cut-off (mean minus 1 standard deviation) were applied.Taking as a reference the first method, the effect of using different scoring methods on the percentage of student failure was evaluated. Furthermore, correlation studies between the results obtained with these scoring methods and the grades reported by the examinees during the medical school curriculum were performed. It was found that the first method generated a more realistic pass/fail rate compared with the two other methods. Furthermore this method, which has been used for the last 10 years for administering internal medicine examinations, showed better correlation coefficients with the curriculum scores.

RA associates with an increased burden of cardiovascular disease, which is at least partially attributed to classical risk factors such as hypertension (HT) and dyslipidaemia. HT is highly prevalent, and seems to be under-diagnosed and under-treated among patients with RA. In this review, we discuss the mechanisms that may lead to increased blood pressure in such patients, paying particular attention to commonly used drugs for the treatment of RA. We also suggest screening strategies and management algorithms for HT, specific to the RA population, although it is clear that these need to be formally assessed in prospective randomized controlled trials designed specifically for the purpose, which, unfortunately, are currently lacking.

Objective. Clinical features in rheumatological conditions often fluctuate with time and this may cause difficulty when evaluating patients whose symptoms or signs do not coincide with their initial rheumatology visit. The aim of this study was to evaluate the outcome of a follow-up system whereby patients with uncertain rheumatological diagnoses at their initial assessment are given easy and rapid access to a rheumatology review. Method. We studied the outcome of SOS (self-referral of symptoms) appointments offered to patients over a 44-month period in one consultant’s clinic at the Staffordshire Rheumatology Centre. The reattendance rates and diagnoses at the initial and subsequent visits were evaluated over a mean period of 26.3 months (range 7–64 months). Results. Thirty-seven patients (23 males, 14 females) were offered SOS appointments during the period studied. At the initial assessment, a provisional diagnosis was recorded for 29 patients (78.4%), whereas the diagnosis was unclear for the other eight patients. At the end of the study period, 10 patients (27%) had requested specialist review via the SOS system after a mean period of 6.8 months (1–19 months). The diagnosis remained unchanged in 8 of the 10 reattenders, whereas the diagnosis was revised in two patients. None of these patients, however, developed an inflammatory arthritis. Conclusion. We suggest that an SOS system of appointments may be a feasible and practical method to follow up patients who have uncertain rheumatological diagnoses at their initial visit. This follow-up system may not easily fit into the current outpatient reforms being implemented in the National Health Service, yet this form of specialist follow-up seems clinically essential for some forms of disease management. The requirements necessary to operate such a system as well as the envisaged pros and cons for the patient and for the rheumatologist are discussed.