bluuebunny/crossref_metadata_2025 huggingface dataset:
Highly configurable low cost remote laboratory with integrated support for learning â?? Hardware design
Authors: Samuelsen Dag A. H. , Graven Olaf H.
Published: April 2013

This paper presents a flexible and low cost design specification for a remote laboratory platform for electronics laboratories. The system utilises a motherboard design and this paper presents both the design of the motherboard, various designs for add on cards and shows how to configure the setup. The design is focused on providing the user with a combination of easy setup and a large freedom in reconfiguration all provided as a low cost solution. The solution is designed to facilitate a natural flow in the creation of all forms of remote laboratories, from the prototyping level up to a permanent installation. This motherboard has connector for both configuration cards, programmable and static as well as for standardized add-on boards for all the configurable components in the laboratory circuit. Acquisition hardware can easily be changed both during development and after the creation of the lab.
Highly configurable low cost remote laboratory with integrated support for learning - Software and learning support
Authors: Graven Olaf Hallan , Samuelsen Dag Andreas Hals
Published: April 2013

A highly configurable remote laboratory system has been create by the authors as a long running project. This paper presents the current version of the software and automated learning support facilities that are parts of this system. The software for the remote laboratory system is created in order to facilitate initially simple, but later on more complex pedagogic support for students using remote laboratories. Current version of the software system includes facilities to limit unwanted behaviour, particularly where students utilise a trial and error approach. The system utilise a batch processing where the aim of the system is to complete all requests within seconds, giving the students the feeling that they have full control over the experiment all the time even when they share it with ten, twenty or more other students.
Fields of Applications for Hybrid Online Labs
Authors: Henke Karsten , Ostendorff Steffen , Wuttke Heinz-Dietrich , Vietzke Tobias , Lutze Christian
Published: April 2013

Based on a grid concept of an interactive hybrid online laboratory we will describe different fields of applications in different learning scenarios. The infrastructure is based on a universal grid concept which guaranties a reliable, flexible as well as robust usage of this online lab. By using the online lab, students are able to design control algorithms with different specification techniques to control electro-mechanical models in the online lab. Additionally, the reconfigurable rapid prototyping platform of the REAL system can be used to test all the taught topics of a given lectures in the field of digital system design. Finally, a special demonstration platform (a ball in a labyrinth on a balance plate) can be used to give the students a better feeling about the possibilities and limitations of remote control and observation via Internet and to evaluate these technologies critically. The implemented online lab infrastructure is based on the iLab architecture of the MIT, which allows to interconnect online labs and to exchange remote lab experiments among different universities worldwide.
Impact of long-term and short-term therapies on seminal parameters
Authors: Elia Jlenia , Imbrogno Norina , Delfino Michele , Mazzilli Rossella , Spinosa Vincenzo , Mazzilli Fernando
Published: April 2013

Aim: The aim of this work was: i) to evaluate the prevalence of male partners of subfertile couples being treated with long/short term therapies for non andrological diseases; ii) to study their seminal profile for the possible effects of their treatments on spermatogenesis and/or epididymal maturation. Methods: The study group was made up of 723 subjects, aged between 25 and 47 years. Semen analysis was performed according to World Health Organization (WHO) guidelines (1999). The Superimposed Image Analysis System (SIAS), which is based on the computerized superimposition of spermatozoa images, was used to assess sperm motility parameters. Results: The prevalence of subjects taking pharmacological treatments was 22.7% (164/723). The prevalence was 3.7% (27/723) for the Short-Term Group and 18.9% (137/723) for the Long-Term Group. The subjects of each group were also subdivided into subgroups according to the treatments being received. Regarding the seminal profile, we did not observe a significant difference between the Long-Term, Short-Term or the Control Group. However, regarding the subgroups, we found a significant decrease in sperm number and progressive motility percentage in the subjects receiving treatment with antihypertensive drugs compared with the other subgroups and the Control Group. Conclusions: In the management of infertile couples, the potential negative impact on seminal parameters of any drugs being taken as Long-Term Therapy should be considered. The pathogenic mechanism needs to be clarified.
Animal experimental model of Peyronie’s disease: A pilot study
Authors: Cerruto Maria Angela , D’Elia Carolina , Molinari Alberto , Cavicchioli Francesca Maria , D’Amico Antonio , Artibani Walter
Published: April 2013

Objective: The Peyronie's disease (PD) is an idiopathic disorder of connective tissue of the penis, that involves the tunica albuginea of the corpora cavernosa and the adjacent areolar space. It is a growing clinical evidence to support the therapeutic potential of mesenchymal stem cells and histological findings has assumed a possible application of lipofilling technique in patients with PD. The objective of this experimental study is the creation of a murine experimental model of PD, evaluating with MRI the penis of the rats (feasibility study), in order to plane the application of lipofilling technique in an animal model. Methods: Four male Wistar rats were anesthetized, fixed in prone position and subjected to MRI. The animals underwent, subsequently, an injection of thrombin in the tunica albuginea and MRI images were acquired at 7 and 21 days after injection with incision of the dartos. Results: The MRI acquisitions, both in coronal and axial projection, showed an adequate visibility of the anatomical structures. At 7 days after thrombin injection with the dartos incision it was evident an oedematous portion, visible as a hyperintense area, located at the injection area. At 21 days after injection, oedema was partially resolved: the injection part of the hyperintense area remains unchanged, while the remaining area appears to be part of a re-absorption and re-organization process. Conclusions: Since none of the various treatment modalities currently available for the management of PD is able to bring healing, the researchers’ attention is increasingly directed towards innovative treatment programs, such as the use of stem cells of mesenchymal origin. At the present time, the research in PD is hampered by the lack of universally accepted animal model and this is likely attributed to the limited insight into PD mechanisms and the difficulties faced by current animal models to truly represent the complexity.
Lack of significant difference between internal spermatic vein and brachial vein ischemia modified albumin levels in patients with varicocele
Authors: Aliyazicioglu Yuksel , Ozbek Emin , Ozcan Levent , Cakir S. Sami , Dursun Murat
Published: April 2013

Varicocele is the most common and surgically correctible cause of male infertility in men attending to infertility clinics. Infertility affects 15% of all couples and male factor is the primary or contributing cause in 40% to 60% of cases. Varicocele has been shown to cause male infertility in about 15% of infertile couples. Molecular mechanisms responsible from varicocele induced testicular dysfunction and male infertility have not been completely unknown. Recent years have witnessed a huge amount of scientific works devoted to the mechanism of varicocele associated male infertility and rapid progress in research on its cellular and molecular mechanisms, including apoptosis and oxidative stress of germ cells. Here we evaluated internal spermatic vein and brachal vein ischemia modified albumin (IMA) level in 40 adult male patients with varicocele. IMA level was analyzed using albumin cobalt-binding test. Spermatic vein and brachial vein IMA levels were 0.381 ± 0.135 ABSU (absorbance units) and 0.385 ± 0.131 ABSU, respectively. There was no statistically significant difference between the two areas. IMA levels in the internal spermatic vein of patients with varicocele should not be used as a marker of hypoxia.
Peyronie’s disease: A “triple oxygenant therapy”
Authors: Ciociola Francesco , Colpi Giovanni Maria
Published: April 2013

Objectives: To evaluate the effects of upregulators of nitric oxide in one patient with Peyronie’s disease, after non significant improvement following intracavernosal verapamil. Methods: A 20-years-old Caucasian male presented with penile induration in flaccid state, persistent during erection and associated with mild pain at third middle of penis. After treatment with intracavernosal verapamil for 4 months with relief of penile discomfort, followed by counseling on the use of penile extender for at least 6 hours per day, he was prescribed pentoxifylline associated with tadalafil plus levo-arginine, propionil-carnitine and Vitamin B3. Results: After almost 2 years, the septal thickness was reduced at ultrasound evaluation after this “triple oxygenant therapy”. Conclusion: NO-iNOS biology in Peyronie patients is the very protagonist in modulating penile fibrosis through up-regulation of NO-cGMP pathway that influences penile health by preventing and reversing fibrosis in the tunical albuginea.
Abdominoscrotal hydrocele with bilateral hydronephrosis in an adult: Case report
Authors: Mutlu Bircan , Ilbey Yusuf Ozlem , Bitkin Alper , Tas¸çı Ali I˙hsan
Published: April 2013

Abdominoscrotal hydrocele is a rare entity with unclear etiology which may be diagnosed with general examination and ultrasound imaging. During examination it may misinterpreted as acute urinary retention of the bladder (globe-like) especially if associated with hydronephrosis. It should be treated surgically. Here we present a case of left abdominoscrotal hydrocele with accompanying left grade 2 and right grade 1 hydronephrosis.
Isolated pump erosion of an inflatable penile prosthesis through the scrotum in a diabetic patient
Authors: Talib Raidh A. , Shamsodini Ahmad , Salem Emad A. , Canguven Onder , Al Ansari Abdulla
Published: April 2013

Isolated pump erosion is a rare complication in patients with inflatable penile prosthesis. We describe a case of a diabetic patient who underwent inflatable penile prosthesis implantation with subsequent isolated pump erosion. Repeated attempts of conservative repair of the erosion failed. Finally, the inflatable penile prosthesis was replaced with a malleable one to avoid new pump erosion. In case of isolated pump erosion, replacement of the inflatable penile prosthesis with a malleable one looks to be a good alternative salvage treatment for the patient.
Investigation of aggravating psychosocial factors on health and predictability of smoking and alcohol use in post adolescent students
Authors: Barmpagianni Effrosyni , Travlos Antonios , Kalokairinou Athina , Sachlas Athanasios , Zyga Sofia
Published: April 2013

Purpose of this study is to explore those factors which affect the health of students in postadolescent age, focusing on smoking and alcohol use, especially in regard to ways of predicting adoption of this behavior and its frequency to detect future users of tobacco and alcohol use but also high-risk groups, i.e. those people who are led to abuses. On the basis of the research part is the Theory of Planned Behaviour, the axes of which are to be investigated. Specifically, the factors evaluated, except for population parameters, behavioral attitudes, i.e. attitudes towards the behavior of tobacco use and alcohol regulations subjective perceptions and perceptions of control, perceived behavioral control and self-efficacy. Intention is explored to continue or start using tobacco and alcohol in the future and evaluate the behavior. The sample consisted of 138 students of postadolescent age, 18-25 years of both sexes, all of the University of Peloponnese and the Technological Educational Institute of Kalamata, Department of Sparta, Greece. The results of a series of statistical analysis, via SPSS 21.0 statistical program revealed the predictive power of perceived behavioral control and subjective norms to the intention of interpreting 64% of the variance of the latter, of the attitudes toward alcohol in relation to intention that interpret 69% of the variance, of the normative beliefs toward smoking with 69% range of interpretation to the dependent variable, of the perceived behavioral control of smoking with 72% and of the attitudes toward smoking with 77% of interpretation. The results demonstrate the significance and application in universities and technological educational institutes appropriate primary preventive interventions for students nonusers of tobacco and alcohol and appropriate programs of secondary and tertiary prevention in heavy users of tobacco and alcohol use and high-risk individual.
The hyponatremias again: a search for fundamental principles
Authors: Sgambato Francesco
Published: April 2013

Not available
Impact of NSAIDs on cardiovascular risk and hypertension
Authors: White William B. , Cruz Christina
Published: April 2013

Introduction: In recent years, there has been a great deal of evaluation of the cardiovascular (CV) effects of the non-steroidal anti-inflammatory drugs (NSAIDs) and the selective cyclooxygenase- 2 (COX-2) inhibitors. Materials and methods: In this brief review, the focus is on both effects of the NSAIDs and COX-2 inhibitors on blood pressure and CV events. The literature was searched using PubMed for both clinical trials and observational studies reviewing the relations among NSAIDs, blood pressure, and CV events. Results: Clinical trial results for NSAIDs and COX-2 inhibitors have shown varying levels of destabilization of blood pressure control in treated hypertensive patients as well as variable incident rates of the development of arrhythmias, congestive heart failure, myocardial infarction, and stroke. Discussion: The non-selective and COX-2 selective NSAIDs can be used with care in selected arthritis patients with hypertension and stable CV disorders (excluding congestive heart failure and moderate to severe kidney dysfunction) when the individual clinical benefit of antiinflammatory therapy outweighs the CV and gastrointestinal risk.
Possible left endoventricular myxoma in a patient with deep vein thrombosis of the lower limbs: a case report
Authors: Galimberti Daniela , Navazio Alessandro , Salvarani Carlo , Bajocchi Gianluigi , Dolzani Paolo , Assirelli Elisa , Casali Anna M. , Leone Maria C. , Pizzini Attila M. , Silingardi Mauro , Arioli Dimitriy , Morini Lorenzo , Favali Davide , Iori Ido
Published: April 2013

Introduction: We describe an unusual case of left ventricular myxoma associated with deep vein thrombosis (DVT). Materials and methods: A 79-year-old woman was admitted with bilateral proximal DVT that developed while she was on warfarin. The anticoagulant therapy had been started (after 2 weeks of low-molecular weight heparin) 1 month earlier in a Cardiologic Unit, where the patient had been treated for ‘‘left ventricular thrombosis associated with acute pericarditis’’. After discharge, the patient continued to experience malaise, recurrent dizziness, dyspnea, flushing, and progressively severe leg swelling despite transthoracic echocardiography (TTE) findings of normal left ventricular function. She was finally admitted to our Unit for ultrasound studies for possible DVT. On admission the INR was in the therapeutic range with increased C-reactive protein (CRP), thrombocytopenia, mild anemia, anti-PF4 antibodies, lupus anticoagulant (LAC), a positive direct Coombs test, and mildly increased anti-platelet and anticardiolipin antibody levels. Malignancy, SLE, and inherited thrombophilia were excluded by a broad-spectrum instrumental and laboratory investigation. Since heparin-induced-thrombocytopenia could not be excluded, the warfarin was replaced with fondaparinux (7.5 mg/day). Given the persistence on TTE of a ‘‘small floating mass’’ at the left ventricular apex, we suspected the previously diagnosed thrombosis was actually an unusually located myxoma, and this diagnosis was confirmed by CT and MRI. The patient also had markedly increased serum levels of interleukin 6 (IL-6), regarded by many as a marker of cardiac myxoma and the source of the constitutional symptoms and immunologic features (‘‘activity’’) of these lesions. The patient is now well except for recurrent flushing episodes. The IL-6 level is still high although the ESR, CRP, LAC have normalized. Since isolated IL-6 increases are associated with recurrence in PMR patients, we consider our patient at risk for relapse of systemic illness. Results: Three cases of cardiac myxoma associated with DVT have been reported. Myxoma production of IL-6 could explain the extracardiac symptoms and the inflammatory/autoimmune activation that caused the DVT. Discussion: Although histologic confirmation is lacking, the features of this case strongly suggest an atypical-site myxoma, in particular the concordant findings generated by the various diagnostic exams and unchanging nature of the ventricular lesion during follow-up.
Management of chronic obstructive pulmonary disease exacerbations in Internal Medicine
Authors: Belmonte Gelorma , Muratori Marilena , Leandri Paolo , Pasquale Angelo , Reta Massimo , Nardi Roberto
Published: April 2013

Introduction: Chronic obstructive pulmonary disease (COPD) is the second leading cause of hospitalization in Internal Medicine departments in Italy and the fourth leading cause of death all over the word. By 2020, COPD will be the third leading cause of death and the fifth leading cause of disability. It is — along with chronic congestive heart failure — one of the most common causes of unscheduled hospital readmissions, and as such it represents a significant economic burden for the health-care system. Exacerbations of COPD are important events in the natural history of this prevalent condition. Discussion: This review provides a comprehensive state-of-the-art look at prevention and management of COPD exacerbations. Treatment of these episodes has to be tailored to the severity of the clinical presentation. We now have a wide range of therapeutic available options, based on the results of clinical trials. Management of the acute event should include the necessary measures (mainly the administration of inhaled short-acting bronchodilators, inhaled or oral corticosteroids, and antibiotics), with or without oxygen and ventilator support. Conclusions: To improve the management of COPD exacerbations, the focus of care must be shifted from the episodic acute complications to their systematic prevention. The management of COPD, which is often associated with multiple co-morbidities, is complex and requires a tailored, multifaceted and multidisciplinary approach. Integrated care for COPD also requires that patients be informed about their condition, that they participate actively in their care, and that they have easy access to the necessary health-care services.
The invention of arterial hypertension
Authors: Cagli Vito
Published: April 2013

Not available
The role of 18F-FDG PET/CT in the management of large-vessel vasculitis: applications and limitations in clinical practice
Authors: Mattoli Maria V. , Treglia Giorgio , Leccisotti Lucia , Giordano Alessandro
Published: April 2013

Introduction: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) plays a key role in oncology, and it is now being used increasingly to diagnose, characterize, and monitor disease activity in inflammatory disorders, including vasculitis. Unfortunately, its role in the management of vasculitis is still not well-defined, and clinicians are often unsure how this metabolic imaging technique should be used in these diseases, although its usefulness in diagnosing large-vessel vasculitis has been clearly demonstrated. Materials and methods: We reviewed the literature about the use of PET/CT in the management of vasculitis in an attempt to identify the applications and the limitations of this technique in clinical practice. Results and discussion: Our literature review revealed that 18F-FDG PET/CT is a useful tool for diagnosing vasculitis (especially when the symptoms of the disease are non-specific); guiding biopsy procedures (areas with high glucose consumption); evaluating disease extension; and monitoring treatment responses. The main limitations of this method are the relatively low spatial resolution of the tomograph, which can lead to false-negative results in the presence of small-vessel vasculitis, and risk of false positive results, especially those related to the presence of atherosclerosis and to post-treatment vascular remodeling.
Boussignac CPAP in acute respiratory failure
Authors: Lari Federico , Savelli Francesco , Giostra Fabrizio , Bragagni Gianpaolo , Di Battista Nicola
Published: April 2013

Introduction: The application of continuous positive airway pressure (CPAP) is one of the most important therapeutic interventions used in patients with acute respiratory failure (ARF) secondary to acute cardiogenic pulmonary edema (ACPE). Thanks to its positive effects on both hemodynamics and ventilation, CPAP improves clinical and blood-gas parameters. Compared with standard oxygen therapy, use of CPAP is associated with decreased mortality and reduced need for intubation in these patients. Aim of the study: This review examines the principles of CPAP, techniques and equipment used to deliver it, and clinical applications. Special emphasis is placed on CPAP delivered with the Boussignac device. Discussion and conclusions: In emergency departments, this simple, lightweight, disposable device has proved to be well tolerated and similar to Venturi-like flow generators in terms of effectiveness. These findings suggest that Boussignac CPAP might be useful for managing ARF in non-critical care areas where other more complicated CPAP equipment (Venturi-like flow generators and ventilators) are not available (for example, in general medical wards).
Ticagrelor
Authors: Airoldi Gianluca , Campanini Mauro
Published: April 2013

Antiplatelet drugs are the cornerstone of treatment for patients with acute coronary syndromes (ACS) who undergo percutaneous coronary intervention. Clopidogrel and aspirin improve long-term clinical outcomes in these patients and have become a standard of care. However, many patients still experience ischemic/thrombotic events, and it appears that insufficient response to both aspirin and clopidogrel contribute to this failure. Clopidogrel is a prodrug that is metabolized in the liver to its active form. It inhibits platelet aggregation induced by adenosine diphosphate (ADP) by irreversibly binding to the ADP purinergic receptor (P2Y12) on the platelet surface. Prasugrel, a novel thienopyridine, exhibits more potent antiplatelet effects with lower interpatient variability and more rapid onsetof activity. All thienopyridines, however, have pharmacological limitations, which have fueled the search for more effective non-thienopyridine P2Y12 inhibitors. Promising results have been reported with ticagrelor, the first oral P2Y12 receptor antagonist with reversible effects. Ticagrelor does not require metabolic activation. In vivo one active metabolite is formed whose potency and pharmacokinetic properties are very similar to those of the parent compound, but it probably plays a minor role in ticagrelor’s antiplatelet effects. Ticagrelor offers more rapid and more pronounced platelet inhibition than other antiplatelet agents. Furthermore, the reversibility of its effects may allow shorter periods of suspension of antiplatelet treatment prior to surgery, reducing the risk of perioperative thrombotic and hemorrhagic events. Preliminary results show a trend toward protection from coronary events and no increased risk for major bleeding compared with clopidogrel. Further investigation is needed, however, to determine the optimal dosage for minimizing bleeding risks and to evaluate its impact on outcomes in various subsets of ACS patients.
Osteoporosis and diabetes mellitus
Authors: Montagnani Andrea , Alessandri Massimo
Published: April 2013

Introduction: Diabetes mellitus (DM) and osteoporotic fractures are major causes of mortality and morbidity in older subjects. Recent reports have revealed close association between fracture risk and DM types 1 and 2 (DM1 and DM2, respectively). Aim of this review is to highlight the importance of these diseases in the elderly and examine certain etiopathogenetic aspects of DM associated osteoporosis, which could be useful in management of diabetic patients. Materials and methods: We searched the Embase and PubMed databases using diabetes, osteoporosis, and bone mineral density (BMD) as search terms and 1989-2009 as publication dates. Discussion: The risk of fractures seems to be increased in both types of DM although DM2 seems to be associated with normal-high BMDs compared with the normal population. This apparent paradox could reflect greater bone frailty in diabetic patients that are unrelated to adipose tissue, hyperinsulinemia, deposition of advanced glycosylation end products in collagen, reduced serum IGF-1 levels, hypercalciuria, renal failure, microangiopathy, and/or inflammation. Diabetic patients’ propensity to fall and multiple comorbidities might also explain their higher fracture rates. The effects of drugs that inhibit bone resorption in diabetic patients are probably similar to those obtained in nondiabetics although there is little information on this issue. In general, effective treatment of diabetes has positive effects on bone metabolism. Metformin acts directly on bone tissue, reducing AGE accumulation, and insulin has direct effects on osteoclast activity. In contrast, the thiazolidinediones seem to have negative effects since they orient mesenchymal progenitor cell differentiation toward adipose rather than bone tissue. Incretin therapy is a newer approach that appears to modify interactions between nutrition and bone turnover (e.g., postprandial suppression of bone resorption). Conclusions: Better understanding of how diabetes and its treatment influence bone tissue could lead to more effective strategies for preventing fractures in diabetic patients. More investigation is needed to determine whether conventional osteoporotic therapy is fully effective in patients with DM.
Geriatric medicine and health care system: how can they fit together?
Authors: Pahor Marco , Cesari Matteo
Published: April 2013

Not available
Internal Medicine: experience and planning for close integration with territorial reference points
Authors: Fabi Massimo
Published: April 2013

Not available
Simultaneous care and frail patients: are we on target?
Authors: Mazzi Giorgio
Published: April 2013

Not available
The pharmacology and activity of non-steroidal anti-inflammatory drugs (NSAIDs): a review of their use as an adjuvant treatment in patients with HBV and HCV chronic hepatitis
Authors: Fiorino Sirio , Cursaro Carmela , Lorenzini Stefania , Loggi Elisabetta , Brodosi Lucia , Cattani Laura , Cuppini Andrea , Bernardi Mauro , Andreone Pietro
Published: April 2013

Introduction: Different DNA and RNA viruses exploit common strategies to support their persistence and replication in infected individuals. In particular, the hepatitis B virus (HBV) and the hepatitis C virus (HCV) cause major health problems worldwide. These pathogens exert an immunosuppressive role by inducing the persistent activation of cyclooxygenase-2 (COX-2) and an increased synthesis of prostaglandin E2 (PGE2). The suppression of this proinflammatory network by non-steroidal anti-inflammatory drugs (NSAIDs) has been proposed as a therapeutic approach to decrease viral replication. Materials and methods: In this review, the role of inflammation in the support of viral replication and NSAIDs and ketoprofen pharmacology are briefly discussed. In addition, studies that have investigated the use of NSAIDs for the treatment of HBV and HCV chronic hepatitis, which were identified by a systematic literature search of PubMed and MEDLINE, are reported. Results: To date, pegylated-interferon (PEG-IFN) and/or nucleot(s)ide analogues and PEG-IFN and ribavirin remain the standard therapy for HBV and HCV chronic hepatitis, respectively. Discussion: The use of NSAIDs in patients with chronic viral hepatitis has only a ‘‘historical’’ interest. Nevertheless, the possible usefulness of ketoprofen with PEG-IFN and ribavirin for HCVinfected patients, non-responders to standard therapy or with genotype 1, should be evaluated in future clinical studies.
The myelodysplastic syndromes: diagnosis, prognosis and therapy
Authors: Clissa Cristina , Finelli Carlo , De Vivo Antonio
Published: April 2013

The authors conducted a systematic review of the medical literature published in the past 15 years on the myelodysplastic syndromes (MDSs). The MDSs are typically seen in the elderly, and primary and secondary forms can be distinguished. This heterogeneous group of hematologic diseases is caused by clonal disorders of pluripotent hematopoietic stem cells. The pathogenesis of the syndromes appears to be multifactorial. Genetic damage, spontaneous or induced by environmental or iatrogenic factors, leads to abnormal proliferation and apoptosis of bone marrow stem cells. The most common presentation is anemia, alone or associated with thrombocytopenia and / or neutropenia, accompanied by the related symptoms and clinical signs (asthenia, fatigue, bleeding, recurrent infections). The diagnosis involves the exclusion of other causes of cytopenia and is based on well-defined, internationally recognized criteria, which are mainly morphologic and cytogenetic. Accurate diagnosis of MDS is essential for prognostic evaluation and for estimating the risk of progression to acute myeloid leukemia (AML). The risk is rated according to the International Prognostic Scoring System (IPSS), which includes 4 levels (low, intermediate-1, intermediate-2, and high). The risk class is a major determinant of the therapeutic approach. Apart from supportive care (transfusions), the main therapeutic tools are erythropoiesis-stimulating agents (ESAs), iron-chelating agents, immunomodulatory drugs, demethylating agents and, in selected cases, allogeneic bone marrow transplantation.
Generic drugs: myths, facts, and limitations
Authors: Marzo Antonio , Porro Elisabetta , Barassi Anna
Published: April 2013

Bioequivalence (BE) has always been an important pharmaceutical area, particularly (but not solely) in Mediterranean region, where the use of generic drugs is a relatively recent development. The lack of new therapeutic molecules has concentrated primary research in the hands of a few large pharmaceutical companies. For smaller companies, this has created opportunities for the development of new formulations of existing drugs (orodispersible tablets that dissolve in the mouth, extended-release tablets, transdermal delivery systems, generic drugs). These applications take advantage of the Abridged New Drug Application (ANDA) procedure, which exempts them from a series of expensive investigations and limits the requirement for clinical testing to bioequivalence trials. Since 1991, bioequivalence trials have been regulated by US Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidelines that provide precise indications on the most specific procedures to be adopted. In spite of these guidelines, however, some aspects of the process have not been fully defined, the most important of which regards the management of endogenous substances. Additional problems are how to manage bioequivalence protocols with drugs that have long half-lives and those whose clearance is characterized by high intrinsic variability. The view that bioequivalence data would be more reliable if they were based on studies in target populations is a myth to be discredited. The present paper reviews issues relative to pharmacokinetics (PK), bioavailability (BA), and bioequivalence, also from an historical viewpoint, and includes a stimulating “questions and answers” section on some key aspects of the bioequivalence of generic drugs.
Role of cystatin C as a biomarker of acute kidney injury and as an independent long-term predictor of cardiovascular events, mortality and functional outcome
Authors: Marrani Carolina , Zenjelaj Teuta , Bartoli Daniela , Corradi Francesco , Innocenti Rinaldo
Published: April 2013

Introduction Serum cystatin C measurements as an early biomarker of acute kidney injury (AKI) is gaining acceptance as studies confirm and define its usefulness. The aim of this study is to determine whether increase in serum cystatin C has an impact on long-term mortality, independently from the presence of the kidney injury itself.Materials and methods A retrospective study (20-month follow-up) was conducted in 173 not selected hospitalized patients. According to serum cystatin C concentrations, patients were stratified in risk classes by quartiles (≥0.55 and <1 mg/L; ≥1 and <1.17 mg/L; ≥1.17 and 1.57 mg/L; ≥1.57 and ≤5.29 mg/L). We compared the association of cystatin C levels with the risk for long-term mortality, after adjustment for age, sex, race and heart failure risk factors.Results A relationship with higher serum levels of cystatin C and mortality was found in patients with and without AKI, being stronger in patients without AKI. After multivariate adjustment, the highest quartile of cystatin C (>1.5 mg/L) was associated with a lower risk for long-term mortality. The statistical analysis (Cox regression) of the independent variables as far as mortality is concerned confirmed the significance of our result (RR 3.60; IC 1.73–7.48; p = 0.001).Conclusions In summary, elevated serum cystatin C level (>1.5 mg/L) was strongly and independently associated with negative clinical outcomes such as mortality and cardiovascular events, independently from the kidney injury itself. The dosage of cystatin C might play an important role in clinical practice for the assessment of cardiovascular risk stratification.
The emerging role of whole-body 18F-fluorodeoxyglucose positron emission tomography in patients with sarcoidosis
Authors: Taralli Silvia , Treglia Giorgio , Giordano Alessandro
Published: April 2013

IntroductionThe purpose of this article is to examine the emerging role of whole-body positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in patients with sarcoidosis.Materials and methodsWe reviewed the literature on the use of FDG-PET in patients with sarcoidosis to identify how this technique is being applied in clinical practice.Results and discussionOur review shows that: 1) sarcoidosis is commonly associated with increased FDG uptake. Therefore, positive findings should be interpreted with caution when FDG-PET is being used to distinguish benign from malignant abnormalities; 2) FDG-PET seems to be a very useful molecular imaging method for staging sarcoidosis, identification of occult sites of involvement, guiding biopsy procedures, and monitoring patients’ responses to treatment; and 3) in patients with sarcoidosis, the diagnostic accuracy of FDG-PET is superior to that of 67Ga scintigraphy.
Ticlopidine-induced cholestatic hepatitis: A case report and review of the literature
Authors: Anastasio Luigi , Manno Valerio , Carbone Maria , Lentini Nicola , Baldari Sandro , Sofia Lucia , Topa Giuseppe , Arone Antonio
Published: April 2013

Introduction Cholestatic hepatitis is frequently a drug-related syndrome. We describe the case of a 57-year-old man who developed cholestatic hepatitis two months after starting therapy with ticlopidine following a carotid endarterectomy.Materials and methods The patient presented with anorexia, nausea, and dark-colored urine. The work-up included laboratory tests and imaging studies of the liver (ultrasound and magnetic resonance imaging). The authors analyze the case using the scale developed by Maria and Victorino for the diagnosis of drug-induced hepatitis, the Naranjo algorithm for adverse drug reactions, and the RUCAM algorithm for causality assessment of hepatotoxicity. They also review data from the MedLine database on cases of ticlopidine-induced cholestatic hepatitis reported during the period 1982–2011.Results Bilirubin, aminotransferases, alkaline phosphatases, and gamma glutamyl transpeptidase levels were elevated at admission and progressively declined after ticlopidine was discontinued. The absence of biliary obstruction at ultrasonography and magnetic resonance cholangiography, the negative results of viral and immunologic tests, and the resolution of the syndrome after discontinuation of the drug all suggested ticlopidine-induced hepatotoxicity. The assessment of this case with toxicity algorithms confirmed that a causal link to ticlopidine was “probable” or “highly probable.” The patient was treated with ursodesoxycholic acid, clopidogrel (75 mg/day), and (after the laboratory parameters had normalized) rosuvastatin (10 mg/day). No further clinical and laboratory abnormalities have been observed during two month follow-up.Discussion The toxicity of ticlopidine is well established: our review revealed reports of 57 cases of ticlopidine-induced cholestatic hepatitis during the period 1982–2011. The mechanisms underlying the toxic effects of this drug are not clear, but they are probably related to the chemical structure of the drug. The syndrome is usually completely reversible with discontinuation of the drug. We stress the importance for the appropriate use of this drug and the need for adequate follow-up of patients.
Clinic, complex and complicated patient, relations and connexions
Authors: Cavicchi Ivan
Published: April 2013

To know the complexity of patient the clinic should think about the relations of complexity which can bond scientific evidence and doctor and patient. To think and to act according to the relations means to settle a clinic, pragmatic and reasonable rational.
Evaluation of the complexity of nursing care in Internal Medicine using two different methods
Authors: Rocco Maria J. , Papetti Alberto
Published: April 2013

IntroductionItaly is abandoning the hospital organization model based on clinical specialty divisions in favour of the model based on the intensity of care, in which patients are admitted to “the hospital sector most appropriate to their health-care needs, which are related not only to the type of hospitalization, but also to the clinical condition and the degree of dependence”. This model includes nursing care, which is organized into health-care sectors based on the complexity of the care required.Materials and methodsWe evaluated the complexity of nursing care in the Operative Unit of the Internal Medicine ward in Legnano hospital using two different methods: the Informative Nursing Performance System (INPS) and the Professionalizing Care Method (PCM). The former was used in a 30-day survey conducted in 2010. Data were collected by trained members of the Unit's nursing staff using an electronic data collection form created with Microsoft Excel®. The second method was used during a multicenter study conducted in 2009 to validate the PCM: data were collected for 150 consecutive days by trained members of the Unit's nursing staff using an electronic data form managed centrally by the organizer of the study.ResultsThe INPS-based survey found that 53.3% of the patients require highly complex nursing care. In the PCM survey, 61% of the patients required nursing care whose complexity was classified as medium-to-high or high. The data collection form used in the INPS survey was simpler and easier to use, with more intuitive questions that could be answered more rapidly (on the average, a total of 2 minutes). The PCM form was more detailed and more difficult to complete (average: 10 minutes after the first month of the survey). However, the PCM form was more complete: it considered a number of variables including the evaluation report and the context, and it can be used in place of the initial nursing assessment for elaborating a care plan.DiscussionThe two methods cannot be compared because of differences related to the duration of the surveys, the number of patients evaluated, the number of complexity classes used, and the manner in which the data were elaborated. The results of the two surveys were similar, however, and this finding has served as a starting point for reflection on the reorganization of the Internal Medicine areas of the new Legnano hospital in accordance with the intensity of care model.
Iloprost infusion by a new device as a portable syringe pump: safety, tolerability and agreement
Authors: Faggioli Paola , Sciascera Alba , Giani Leopoldo , Mazzone Antonino
Published: April 2013

Background Iloprost, prostacyclin (PGI2) analogue, effective in treatment of peripheral arterial disease, secondary Raynaud's phenomenon (RP) to connective tissue disease (CTD), vasculitis, pulmonary hypertension, is usually infused through peristaltic pump, or recently through a flow regulator.Materials and methods We tested a new portable syringe pump (Pompa Infonde®, Italfarmaco S.p.A., Cinisello Balsamo, Milano) on 120 patients affected by RP to CTD and cryoglobulinaemia, in iloprost therapy with a flow regulator.Results Iloprost infused through portable syringe pump is better tolerated, better appreciated by the patients and nurses and no difference was observed on therapeutic effects, with a lower incidence of side effects statistically significant. Only 3 patients were unable to tolerate the device (2 for changes in pressure and 1 for fear) and shifted to traditional method of iloprost infusion.Conclusions Iloprost infusion through the portable syringe Pompa Infonde® appears to be safe, better tolerated, more acceptable and equally effective compared to infusion through a flow regulator.
Hypotermia in the elderly
Authors: Bragagni Gianpaolo , Alberti Anna , Castelli Giuliano , Lari Federico
Published: April 2013

IntroductionAn 88-year-old woman suffered a cerebrovascular accident and was found on the floor of her cold house.Materials and methodsAt the time of admission to our division, the patient was unresponsive with a rectal temperature of 28 °C, blood pressure of 120/80 mmHg, and a heart rate of 40 bpm. The cerebral CT revealed a hypodense lesion in the temporal region. The ECG showed sinus bradycardia, prolonged PR and QTc intervals, and a classic “J” (Osborn) wave that was most pronounced in the lateral and inferior leads. The patient presented a low respiratory rate, hypoventilation, severe acidosis (both respiratory and metabolic), hyperkalemia, elevated liver enzymes, mild anemia, hyporeflexia, and sluggish pupil responses.ResultsDuring rewarming with thermic blanket and heated intravenous fluids, the respiratory condition improved, and the ECG alterations disappeared. Twenty-four hours later, however, the patient died suddenly due to cardiac asystole.DiscussionThis report analyses the effects of hypothermia and its clinical manifestations and provides a brief discussion of the electrophysiologic mechanisms underlying Osborn waves and the other electrocardiographic changes associated with hypothermia.
Endothelial dysfunction in hypertension: pathophysiological mechanism or marker of cardiovascular risk?
Authors: Ghiadoni Lorenzo , Virdis Agostino , Stea Francesco , Bruno Rosa M. , Taddei Stefano
Published: April 2013

Introduction Vascular endothelial production of nitric oxide (NO) plays an important role in the modulation of vessel tone and structure, protecting the vascular wall from atherosclerosis. In pathological conditions, however, the endothelium also produces pro-atherogenic substances (mainly reactive oxygen species), which inactivate NO. The Endothelial dysfunction, induced by reduced NO availability, is known to contribute to the development and progression of vascular damage. For this reason, endothelial function has been a major focus of cardiovascular research in the last few decades. Because NO has a very short half-life and its in vivo measurement is difficult, many researchers prefer to measure its biological activity, particularly the NO-dependent vasodilation, at the level of the coronary and peripheral circulation by endothelial stimuli. The most widely used technique involves measurement of brachial artery flow-mediated dilation. This test allows non-invasive evaluation of endothelium-dependent vasodilation in the peripheral macrocirculation induced by a mechanical stimulus (increase in shear stress caused by 5 minutes of forearm ischemia). The vasodilatatory response is reduced in the presence of major cardiovascular risk factors, particularly essential hypertension. Conclusions Studies conducted mainly in high-risk patients have demonstrated that endothelial dysfunction within the coronary or peripheral circulation is predictive of cardiovascular events (independently of classical risk factors). Drug therapy can improve endothelial function by increasing the availability of NO (a possible adjunctive benefit in terms of preventing vascular damage and improving the prognosis). Future studies will establish whether the evaluation of endothelial function by non-invasive, standardized, reproducible, low-cost techniques is an important test for cardiovascular risk stratification in clinical practice.
Long QT, alteration of calcium-phosphate product, prevalence of ventricular arrhythmias and sudden death in peritoneal dialysis patients: a Holter study
Authors: Di Loreto Pierluigi , Ronco Claudio , Vescovo Giorgio
Published: April 2013

Materials and methods We studied 79 patients on peritoneal dialysis. Each underwent 24-h electrocardiography (Holter monitoring) and measurement of the rate-corrected QT interval (QTc). We analyzed the correlation between QTc and plasma levels of Ca++, PO4−, K+, Na+, Mg++, and parathyroid hormone (PTH). Results The mean QTc was 0.445 ± 0.04 s. In 55 patients, the QTc was prolonged (> 0.45 s). Mean laboratory values for the group were: PTH 344 ± 25 pg/mL, Ca++ 9.27 ± 0.11 mg/dL, PO4− 5.5 ± 1.5 mg/dL, Na+ 139.6 ± 3.4 mmol/L, K+ 4.04 ± 0.64 mmol/L, and Mg++ 2.52 ± 0.43 mg/dL. Holter monitoring revealed complex premature ventricular contractions in 44 patients, monomorphic premature ventricular contractions in 16, and nonsustained ventricular tachycardia (NSVT) in 10. The QTc was significantly correlated with plasma levels of PO4− (r = 0.045, p < 0.05), PTH (r = 0.077, p < 0.02), and Ca++ (r = 0.076, p < 0.02). Eleven patients had Lown class 4a or 4b ventricular arrhythmias, and their mean QTc was 465 ± 0.02 ms. Ten had NSVT and their QTc was 464 ± 0.03 ms. Eleven patients died suddenly (mean QTc 465 ± 0.03 ms); all 11 had either NSTV or Lown class 4 ventricular arrhythmias. Conclusions Long QTc seems to be associated with an increased prevalence of ventricular arrhythmias that may be the cause of sudden cardiac death.
Abstract Book del XVII Congresso Nazionale FADOI 5-8 maggio 2012, Rimini
Authors: Editors The
Published: April 2013

Abstract Book del XVII Congresso Nazionale FADOI 5-8 maggio 2012, Rimini