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Nutritional abnormalities and physical inactivity are risk factors of increased morbidity and mortality in patients with ESRD. Identify and define malnutrition, in particular protein-energy depletion (PEW), is an important task in the management of renal patients. The aim of this multicenter observational study was to implement the assessment of nutritional status and functional capacity in patients on peritoneal dialysis, including tests and validated methods which are relatively easy to apply in daily clinical practice. The study includes all the 133 prevalent patients (80 m, 53 f, age 65 14 years), in peritoneal dialysis treatment (vintage 26 19 months) in 9 centers in Tuscany. We performed anthropometry, bioimpedance (BIA), clinical biochemistry, evaluation of habitual physical activity (RAPA tests) and performance (Sit-To-Stand test), appetite-evaluation questionnaire, and indices including the Malnutrition Inflammation Score (MIS), Geriatric Nutrition Risk Index (GNRI), Charlson comorbidity index, Barthel and Karnowsky index. The latter showed a condition of dependence in 7.2% and 19.7% of cases, respectively. Poor appetite was recorded in 48.2%. The majority of patients fell within the overweight / obesity range (51%) with waist circumference values associated with increased cardiovascular risk in 51% of males and 60% of females. At the BIA analysis, a BCMI8 kg/m2 was detected in 39% of patients; an estimated protein intake1.0 g / kg/d was found in 59% of cases; 34% of patients had serum albumin3.5 g / dl; control of acidosis was good (bicarbonate 25.4 3.8 mM) but hyperphosphatemia was present in 64.6% of patients. A condition of sedentary or light physical activity was reported by 65.1% of patients, vigorous activity only by 11.9%. The 86.5% of patients able to perform the Sit-to-stand test reported a lower than the reference values for age and sex. A diagnosis of PEW was possible in 8% of our series, while a MIS score11, indicative of PEW, took place in 12.7% of cases. The values of the MIS correlated directly with age and the degree of comorbidity and inversely with the sit-to-stand test, RAPA tests and appetite level. The data in this study show that single tests indicative of malnutrition disorders are frequent to be found in our series of peritoneal dialysis patients. However, a diagnosis of PEW is quite infrequent. A large percentage of patients are overweight with increased abdominal adiposity, and reduced cell mass and protein intake below recommended levels; the level of habitual physical activity is low, and the level of physical capability is scarce. Therefore it is conceivable a nutritional counseling intervention to increase the intake of proteins, limiting the phosphorus and (when indicated) energy intake and to stimulating spontaneous physical activity or arranging assisted programs for functional rehabilitation. Close monitoring of the nutritional status and implementation of programs of adapted physical activity should have a prominent role in the clinical management of patients on peritoneal dialysis.

The great European expansion of the Age of geographical discoveries was the final outcome of an economic, technical and scientific development, begun centuries before. The author briefly examines the evolution of ships up to the carrack and the caravel, which were the protagonists of oceanic voyages, and of sailing techniques, including navigation by the stars which allowed sailors at the end of the 15th century to know the position of the ship even on the open sea. The contribution of scholars is also examined and their noteworthy share in building new instruments and in elaborating scientific theories about the shape of the world and about the distribution of sea and land, upon which great sailors founded those projects, that would lead to the exploration of New Worlds.

In 1989 researchers evaluated the impact of a 3 day course in counseling and interpersonal communication skills for family planning nurses in Ogun State Nigeria on quality of service delivery and on client compliance with follow up appointments. They interviewed 480 clients observed 39 nurses and examined the medical records of 1001 clients who visited the 8 clinics. 97% of clients who spoke to a trained nurse felt the nurse earnestly listened whereas only 66% of those who spoke with an untrained nurse felt this (p

Perfusion of intestinal organs increases in response to acute normovolemic hemodilution (ANH). However, detailed studies on distribution of regional splanchnic organ perfusion during ANH are lacking. We therefore carried out this study to test the hypothesis that ANH does not cause disturbance of physiologic patterns of regional splanchnic organ blood flow. After governmental permission, 22 anesthetized dogs were instrumented to allow invasive hemodynamic measurements and intracardial injection of radioactive microspheres (diameter 15 micro m) for determination of regional organ perfusion. Measurements were made at baseline (hematocrit 37 +/- 3%) and after ANH with 6% hydroxyethyl starch (mol. wt. 200000 / 0.5) to hct 20 +/- 1%. After completion of the protocol, splanchnic organs were removed and dissected into small samples according to anatomical and functional principles. Regional perfusion was determined based on the microsphere content of each sample. Hepatic, intestinal, and pancreatic blood flow increased with ANH. Hepatic arterial blood flow rose by 86%, whereas portal venous perfusion increased by 28%. Small intestine mucosal perfusion was augmented by 68% while the non-mucosal tissue compartment of the gut wall received 32% more blood flow after ANH which is in proportion to the increase in cardiac index after ANH. This redistribution of intestinal flow might be the basis for the preservation of tissue oxygenation during moderate isovolemic anemia.

Hepatorenal perfusion and function were assxssed in 22 dogs undergoing acute normovolemic hemodilution (ANH) to a hematocrit (Hct) of 20% using 6% hydroxyethyl starch (200.000/0.5) as the diluent. Organ perfusion was determined with the radioactive microspheres method. Renal function was assessed by urinary output, creatinine clearance and fractional sodium excretion. Blood volume as well as hepatic function were derived from indocyanine green (ICG) dilution kinetics. Hepatocellular integrity was determined by serum enzymatic activity of glutamate-oxalacetate-transaminase (GOT) and glutamate-pyruvate- transaminase (GPT). ANH to Hct 20% did not change blood volume and mean aortic pressure, while heart rate was slightly elevated (p0.05) by 5 beats per minute and cardiac output increased by 29% (p0.05). In contrast to the liver, where arterial and portal venous blood flow increased (86% and 28%, respectively; p0.05), total renal blood flow as well as intraorgan distribution of renal blood flow remained unchanged post-ANH. While creatinine clearance remained unchanged following ANH, urinary output and fractional urinary excretion increased (p0.05). In response to enhanced hepatic blood flow after ANH, intravascular half-life of ICG was reduced (p0.05) and ICG clearance increased (p0.05). Serum enzymatic activity of GPT decreased upon ANH (p0.05), while GOT activity remained unchanged. ANH to a Hct 20% does not impair hepatorenal function. Increased urinary output points out the necessity for proper adjustment of crystalloid infusion to maintain normal intravascular volume and avoid hypovolemia and the associated risk of tissue hypoxia.

Low Intensity Pulsed Ultrasound (LIPUS) application has been shown to have an encouraging effect in inducing a transient pore formation through cellular membranes. This permeability condition has been demonstrated to be useful in enhancing gene and drug delivery. Nowadays, in the management of NSCLC patients, the use of liquid biopsy has entered the clinical practice. One of the main limits in the analysis of circulating tumor DNA is the low concentration rate of nucleic acids in body fluids. Ultrasound stimulation (US) has been recently demonstrated to be effective for the release of specific circulating tumor biomarkers in many mouse models. We demonstrated the role of US in inducing the release of tumor DNA fragments (rtDNA) in NSCLC without inducing any apoptotic or necrotic event.

Objective One of the most difficult tasks to achieve with the available instrumentations used to study the interaction between ultrasound (US) and cellular model systems is to design an experiment, where only the effects of one physical parameter at a time is evaluated, while all the others are kept constant. The set-ups are usually custom-made, often by means of clinical instrument intended for a different therapeutic purpose. Furthermore, the results are not strictly comparable with others obtained with techniques considered standard in molecular and cellular biology at this time, because there is the need to use non-standard devices to contain biological samples. Sterility, as well as temperature, is not well controlled and reproducibility is usually a major concern. In our study we show the effects of ultrasound treatments on different cellular systems. The experiments are performed with a versatile bench-top US apparatus to be adapted for several in vitro experiments and that allows easy and robust reproducibility using standard set-ups for the cell samples. Methods One main feature of our bench-top US system is that it has been designed in order to use standard plasticware commonly used in molecular biology labs, ensuring the temperature control and sterility conditions needed in the field. We present a set-up where the simultaneous use of a set of transducers operating at different frequencies on the same plate, allows the comparison of the deposition of the same acoustic pressure, whilst evaluating the effect of frequency alone on the readout of the cell experiments. The apparatus modular design also allows the use of a set of transducers operating at the same frequency, in experiments where the throughput is a relevant factor. We demonstrate that it is possible to define the position of the target within all the achievable areas of the acoustic field with sub-millimetric accuracy. Tests for several applications based on biologic effects by ultrasound have been carried out by varying the acoustic parameters such as power, frequency range, sonication time and duty cycle, all controlled within robust protocols executed in automation. Results The resulting data proves that it is possible to perform in vitro experiments for different purposes (i.e. drug delivery, cellular sonoporation, nanoparticles or microbubbles swelling, tissue regeneration, neuronal cell stimulation etc.) keeping the relevant physical parameters of sonication constant, for instance acoustic pressure, but varying the others parameters (i.e. frequency, pulse length or duty cycle etc) one at the time. Conclusions We show that with our apparatus it is possible to obtain robust and reproducible results on cellular experiments, using all the standard devices that are commonly available in biological labs. The improvement on the side of reproducibility and portability of the experiments allows a straightforward comparison between our results and those obtained with other techniques.

A device (1) for ultrasound tests, comprising one or more transducers (4) for generating ultrasound beams with different powers and/or frequencies to be projected in direction of a plurality of targets (11), guaranteeing the separate control of the temperature both of the targets and of the transducers and it allows performing several tests contemporarily, by optimizing the functionality and the efficiency of the device, at the same time by guaranteeing results comparable therebetween for each test, and to this purpose it comprises: a first supporting structure (3) having at least a closed chamber (7; 23) receiving the body of said one or more transducers (4) and it is isolated from a propagation liquid medium, by leaving exposed each respective vibrating surface in contact with said liquid medium at a prefixed distance from the respective targets (11), the closed chamber containing a thermorefrigerating fluid in contact with the body of said one or more transducers; a second supporting structure (10) for said targets (11); means for refrigerating, through said thermorefrigerating fluid, the body of said one or more transducers (4); and means for keeping the liquid medium, which dampens said targets (11), at a predetermined temperature.