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Several factors that underlie health inequality have been studied and defined as the social determinants of health (SDHs). The main SDHs are gender, socioeconomic status (SES), and ethnicity. In this study, disparity was analyzed in the context of vascular diseases (VDs) such as Peripheral Artery Disease (PAD), Chronic Venous Disease (CVD), Abdominal Arterial Aneurysm (AAA), and Carotid Stenosis (CS). This article aims to provide a comprehensive overview of the published evidence of the SDHs in VDs. For this purpose, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Published articles using the Scopus and ScienceDirect databases were searched. The criteria for the articles’ inclusion/exclusion were decided using a modified PICOTS framework. For the selected articles, the data sheets were organized in such a way to extract all data of potential relevance. Our findings showed that in VDs, gender, SES, and ethnicity are very important, with some specific problems for VDs analyzed. In conclusion, having detected the presence of SDHs that act negatively on VDs, a model based on action items for the SDHs associated with VDs was proposed.

This paper models a scenario in which agents, that can be seen as First Responders, smart devices and/or robots explore the environment and exchange information in an emergency situation, i.e., after an earthquake, assessing damages, and searching for people needing assistance. While moving, the agents observe events and exchange the information collected with other agents encountered, thanks to common network connections. When some conditions hold, the agents can upload the collected information to a Control Room/database in the Cloud. The model includes a detailed description of how data are exchanged between agents and stored in the database. A simulated experiment has been carried out in a real-world street network, with the aim of evaluating the feasibility and performances of the approach.

Background Femoropopliteal bypass occlusions are a significant issue in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery, which challenges vascular surgeons and interventional radiologists. Performing a secondary femoropopliteal bypass is still considered the standard of care, although it is associated with a higher complication rate and lower patency rate in comparison with primary bypass. Over the past few years, angioplasty has been commonly used, with the development in endovascular technologies, to treat chronic total occlusions of the native superficial femoral artery, with a good technical success rate and clinical prognosis. The purpose of the study is to assess the outcome of endovascular recanalization of chronic total occlusions of the native superficial femoral artery, in patients unfit for surgery with critical limb ischemia after failed femoropopliteal bypass. Results A total of 54 patients were treated. 77.8 % of the conduits were PTFE grafts; the remainder were single-segment great saphenous veins. The most common clinical presentation was rest pain. Technical success was achieved in 51 (94.4 %) of 54 limbs. Angiographically, 77.8 % of the lesions were TASC II category D, while 22.2 % were TASC II category C. The average length of the native SFA lesions was 26.8 cm. Clinical success, with improved Rutherford classification staging, followed each case of technical success. The median follow-up value was 5.75 years (IQR, 1.5–7). By Kaplan-Meier survival analysis, primary patency rates were 61 % (± 0.07 SE) at 1 year and 46 % (± 0.07 SE) at 5 years. Secondary patency rates were 93 % (± 0.04 SE) at 1 year and 61 % (± 0.07 SE) at 5 years. Limb salvage rates were 94 % (± 0.03 SE) at 1 year and 88 % (± 0.05 SE) at 5 years. Conclusions The endovascular recanalization of chronic total occlusions (CTO) of the native superficial femoral artery (SFA) after a failed femoropopliteal bypass is a safe and effective therapeutic option in patients unfit for surgery with critical limb ischemia.

to update the health profile of populations residing in the national priority contaminated sites (NPCSs) in Sicily Region (Southern Italy) through a description of mortality and hospitalization for causes and through cancer incidence. This new profile is part of the implementation of the epidemiological surveillance system within the new Programme of care intervention for health protection in these populations and in the new Regional Prevention Plan.geographic population survey providing, for each NPCS considered in this study, a comparison between the local population and the populations of the neighbouring areas.the study population included the residents in the municipalities residing in the NPCSs of Augusta-Priolo, Gela, Milazzo, and Biancavilla.the standardized mortality ratio (SMR), morbidity (SHR), and tumour incidence (SIR), with the respective 95% confidence intervals, were estimated using the Mortality Registry as source for the mortality index, the database of the hospital discharged as source for the morbidity index, and the data from the Regional Network of Tumour Registers as source for the incidence index.in the local comparison, excess of hospitalization in both sexes was reported in Augusta-Priolo for liver cirrhosis, mental disorders, and digestive tract disease, and an excess of incidence and mortality for leukaemia in women and prostate cancer in men. In the NPCS of Gela, there was an excess of hospitalization in both sexes for blood and hematopoietic diseases, circulatory and nervous system diseases, coupled with the same excess of mortality. Excess of incidence and mortality of stomach tumours in men and incidence of lung cancer in women were observed. The area of ​​Milazzo was characterized by an excess of incidence and mortality for melanoma in men. In the municipality of Biancavilla, there is evidence of excess of hospitalization for respiratory diseases and endocrine glands diseases in both sexes, while a mortality excess for circulatory system diseases was highlighted. The excess of incidence of mesothelioma in both men and women was confirmed.data from the new surveillance system help to define the health profile in the NPCSs of Sicily. Even using the local level of comparison, that was added to the traditional approach in geographic studies for the NPCSs available to date, the particular impact of some chronic diseases in these populations has been confirmed also in recent years.

Background: Primary aim was to investigate the diagnostic value of PAS-positive vacuolated lymphocytes on blood smear in Late Onset Pompe Disease (LOPD) patients and, secondly, to evaluate its potential utility in monitoring treatment effects.Methods: We examined blood smear of 26 LOPD patients. We evaluated 10 treated and 16 untreated LOPD patients. Among the latter group, 7 patients later initiated ERT and were tested again 6 months after start. Blood smear was also sampled from 82 controls and 19 patients with other muscle glycogenoses (MGSDs). PAS staining was used to evaluate: (1) presence of lymphocytes with glycogen-filled vacuoles, (2) quantification of vacuolated lymphocytes.Results: We found that PAS-positive lymphocytes were significantly higher in LOPD patients than in controls or other MGSDs (p < 0.05 and p < 0.001, respectively). ROC curve for discriminating between untreated LOPD patients and controls yielded an AUC of 1.00 (95%CI 1.00–1.00; p < 0.0001). PAS-positive lymphocyte cutoff level of >10 yielded sensitivity of 100% (95%CI 78–100%), specificity of 100% (95%CI 96–100%), and positive predictive value of 100%. Patients studied before and after ERT showed a dramatic decrease of PAS-positive vacuolated lymphocytes number (p = 0.016). In other MGSDs, PAS-positive lymphocytes were significantly lower that untreated LOPD patients but higher than controls.Conclusions: Our data suggest that the Blood Smear Examination (BSE) for PAS-positive lymphocytes quantification could be used as a simple and sensitive test for a quick screening of suspected Pompe disease. The quantification of vacuolated lymphocytes appears to be also a valuable tool for monitoring the efficacy of treatment in LOPD patients.

Pompe disease is a rare metabolic disorder due to lysosomal alpha-glucosidase (GAA) deficiency. It is considered as a multi-systemic disease since, although glycogen accumulation is largely prominent in heart, skeletal and respiratory muscles, other organs can also be affected. As regards the vascular system, few reports have documented cerebrovascular malformations in Pompe patients. The aim of this study was to define the presence and type of intracranial arterial abnormalities in a cohort of late onset Pompe disease (LOPD) patients.We have studied 21 LOPD patients with cerebral CT angiography (CTA), using maximum intensity projection and volume rendering technique for 3D-image reconstruction.We found intracranial arterial abnormalities in 13/21 patients (62 %), of whom: 2/21 patients (9.5 %) showed an unruptured intracranial aneurysm (respectively 2 and 4 mm), 10/21 (47 %) had a vertebrobasilar dolichoectasia (VBD) and 1/21 a basilar artery fenestration. Signs of lacunar encephalopathy (insular, capsular and frontal subcortical lesions) were detected in 13/21 patients (62 %) and this correlated with the presence of respiratory impairment (p = 0.017).These findings differ from what has been previously observed in healthy, aged-matched populations and confirm that cerebral arteries abnormalities, mainly involving the posterior circle, are not so rare in LOPD patients and are often accompanied by a lacunar encephalopathy that might represent a hypoxic-ischemic origin. A CTA or an MRA is recommended, in LOPD patients, for early detection of cerebrovascular malformations as they could lead to life-threatening events such as sub-arachnoid haemorrhage or brainstem compression.

While several national and international organizations offer standards for pollution levels and techniques to measure ambient air, there are no consistent metrics or methods for assessing and monitoring indoor air quality (IAQ) for an entire community. In this paper, we develop a framework for monitoring and addressing indoor air pollution in the context of an energy conservation district in Pittsburgh, Pennsylvania, comprised of 518 buildings. This district-based IAQ framework has two major components. The first component is based on an IAQ sampling protocol developed from the U.S. Environmental Protection Agency BASE study. IAQ assessments were performed in eight pilot buildings to evaluate concentrations of particulate matter, volatile organic compounds, carbon dioxide, relative humidity, and temperature. The second component was a communications strategy designed to help building professionals understand IAQ science and translate results into actionable procedures. Both the sampling data and feedback from building stakeholders, informed the development of an IAQ survey, which was used to establish a performance baseline and guide the future operation and maintenance of buildings in the district. This research has far-reaching impacts as there is a need for a replicable framework and actionable program that monitors and assesses IAQ in a wide range of buildings.

The study objectives were to 1) evaluate medication adherence for adults with attention-deficit/hyperactivity disorder (ADHD) treated with 3 times daily (TID) mixed amphetamine salts immediate release (MAS IR) versus once-daily (qAM) MAS extended release (MAS XR) in a randomized, crossover study; and 2) to examine the associations between adherence and efficacy for MAS IR and MAS XR.Sixty-two adults with ADHD were enrolled and 49 completed the study. The treatment condition order (TID-qAM or qAM-TID) was counterbalanced across participants, with an intervening washout period of ≥ 7 days. Adherence was assessed via 3 measures: 1) self-report, 2) pill count, and 3) the Medication Event Monitoring System (MEMS(®)). The primary efficacy measure was the ADHD Rating Scale (ADHD-RS); secondary measures included the Time-Sensitive ADHD Symptom Scale (TASS) and Clinical Global Impressions-Severity of Illness (CGI-S) scale.Adherence to treatment as measured by self-report and pill count was not significantly different between MAS XR and MAS IR. Adherence was significantly better for MAS XR than MAS IR for all of the MEMS(®) measures. The mean change in ADHD-RS, TASS, and CGI-S scores at endpoint was significantly improved for both MAS IR and MAS XR and did not differ significantly between groups. There was not a significant adherence by efficacy interaction.Adults with ADHD adhered equally well with MAS IR as with MAS XR when assessed by pill count and self-report, but not by the MEMS(®) measures. Both treatments significantly reduced ADHD symptoms, and efficacy was not significantly different between groups. Adherence was not associated with treatment outcome.

Hippo signaling pathway is considered a key regulator of tissue homeostasis, cell proliferation, apoptosis and it is involved in cancer development. In skeletal muscle, YAP, a downstream target of the Hippo pathway, is an important player in myoblast proliferation, atrophy/hypertrophy regulation, and in mechano-trasduction, transferring mechanical signals into transcriptional responses. We studied components of Hippo pathway in muscle specimens from patients with Duchenne muscular dystrophy (DMD), Becker muscular dystrophy, limb-girdle muscular dystrophy type 2A and type 2B and healthy subjects. Only DMD muscles had decreased YAP1 protein expression, increased LATS1/2 kinase activity, low Survivin mRNA expression and high miR-21 expression. In light of our novel results, a schematic model is postulated: low levels of YOD1 caused by increased inhibition by miR-21 lead to an increase of LATS1/2 activity which in turn augments phosphorylation of YAP. Reduced amount of active YAP, which is also a target of increased miR-21, causes decreased nuclear expression of YAP-mediated target genes. Since it is known that YAP has beneficial roles in promoting tissue repair and regeneration after injury so that its activation may be therapeutically useful, our results suggest that some components of Hippo pathway could become novel therapeutic targets for DMD treatment.

Background: After noting a significant reduction in aggression and agitation in treatment-refractory patients with molindone augmentation in severely aggressive inpatients, the authors conducted a retrospective medical records review to assess the possible anti-aggressive role of molindone treatment in a larger cohort of treatment-refractory inpatients. Method: Twenty-four weeks of data from thirty inpatients who were consecutively augmented with molindone, including progress notes, orders for seclusion, chemical restraint, and scores on the Agitation-Calmness Evaluation Scale (ACES) were systematically collected. The number of seclusions, number of as-needed medications (PRNs) and ACES scores were used to tabulate the frequency of aggression and agitation episodes during the 8-week period before, 8 weeks after, and 9 through 16 weeks after the initiation of molindone augmentation treatment. Results: Over the observation period of twenty-four weeks, the number of episodes of PRN medication administration ...

OBJECTIVE: Second-generation antipsychotics (SGAs) are far more commonly used in the United States compared to first-generation antipsychotics (FGAs), but the relative safety of SGAs compared to FGAs following acute toxic ingestions has not been studied. METHOD: A retrospective cohort study was performed by chart review of the California Poison Control System electronic database of 1975 cases from the 10-year period 1997 to 2006 involving patients aged 18 to 65 years who ingested a single SGA or FGA. Cases were coded for overall severity of adverse outcome as defined by the American Association of Poison Control Centers criteria and for presence of specific symptoms and treatments. Odds ratios were calculated between SGAs and FGAs for various symptoms, treatments, and outcome severity. RESULTS: Odds of a major adverse outcome or death were significantly higher for SGAs than FGAs (OR = 1.71, 95% CI = 1.09 to 2.71). Patients taking SGAs had higher odds of respiratory depression (OR = 2.39, 95% CI = 1.09 to 5.26), coma (OR = 2.18, 95% CI = 1.30 to 3.65), and hypotension (OR = 1.80, 95% CI = 1.23 to 2.63) compared to those taking FGAs but lower odds of dystonia (OR = 0.12, 95% CI = 0.08 to 0.19) or rigidity (OR = 0.30, 95% CI = 0.10 to 0.90). CONCLUSION: SGAs appear no safer than FGAs in acute overdose. While neuromuscular symptoms appear less frequently with SGAs compared to FGAs, the relatively greater rates of central nervous system depression associated with SGA overdose may be more dangerous. Language: en

Pompe disease is a rare metabolic disorder, due to mutations in the gene encoding acid alpha-glucosidase (GAA), of which infantile and late-onset forms may occur. Aim of the work was to analyze clinical and laboratory data of a cohort of late-onset Pompe disease (LOPD) patients, collected during the last 15 years and to point out unusual phenotypic/genotypic features as well as enzyme replacement therapy (ERT) responses. We diagnosed 30 LOPD patients; at follow-up, they underwent motor, respiratory, cardiac and muscle MRI evaluations. Motor performances were tested by Walton Gardner-Medwin, GSGC and 6MWT tests. Respiratory function was assessed as FVC % in upright/supine position. LOPD presentations were represented by presymptomatic hyperCKemia (37 %), proximal/axial muscle weakness (53 %) and respiratory impairment (10 %). Median diagnostic delay was 8.6 years (±8.8). Atypical features were observed in 4 patients: marked distal muscle weakness and severe hearing loss at onset, as well as leukoencephalopathy and mesial temporal sclerosis during the disease course. By GAA sequence analysis, two causing mutations were detected in 22/30 patients, only one in the remaining 8 subjects. Overall, 29/30 patients harbored the common c.−32−13T>G mutation (2 were homozygous). Two new DNA variations were discovered (c.2395C>G, c.1771C>T). 14 patients received ERT for up to 60 months. Our study confirms LOPD clinical and genetic heterogeneity: atypical features may contribute to expand the clinical phenotype highlighting its multi-systemic nature. A timely diagnosis could allow early ERT start. An accurate follow-up is recommended to evaluate treatment responses.

Muscle β-enolase deficiency is a very rare inherited metabolic myopathy caused by an enzymatic defect of distal glycolysis. So far, the condition has been described in only one patient with mutations in ENO3 in a compound heterozygous state who presented with exercise intolerance, post-exercise myalgia and mild hyperCKemia but no pigmenturia. We describe two men, one Italian and one Turkish, with consanguineous parents, who complained of several episodes of intense myalgia, cramps, generalized muscle tenderness and dark urine. No other family members reported similar symptoms. In both cases, there was a very mild rise in lactate during a forearm exercise test. Muscle biopsy showed minimal changes with no lipid or glycogen accumulation. Biochemical studies on muscle tissue demonstrated a marked reduction of muscle β-enolase activity (20 and 10 % of residual activity, respectively). Molecular genetic analysis of ENO3 gene revealed two novel homozygous missense mutations, (p.Asn151Ser and p.Glu187Lys). Both mutations segregated as expected in the two families. Although quite rare, muscle β-enolase deficiency should be considered in the differential diagnosis of patients presenting with recurrent rhabdomyolysis. It may present also with a more severe phenotype than previously thought.

The autopsy of the mummy of Ferrante I of Aragon, King of Naples (1431–1494) revealed an adenocarcinoma extensively infiltrating the muscles of the small pelvis. A molecular study of neoplastic tissue observed a typical mutation of the K-ras gene codon 12: the normal sequence GGT (glycine) was altered into GAT (aspartic acid). The recorded genetic change represents the most frequent mutation of the K-ras gene in sporadic colorectal cancer and is characteristic of the effects of alkylating agents. Recent studies have focused the importance of some alkylating agents, such as the endogenous N-nitroso compounds (NOC). Increased intake of red meat, such as beef, lamb or pork, induces a significant threefold increase of faecal NOC levels, with a range of exposure in faeces similar to that from tobacco-specific NOC in cigarette smoke. The study of alimentary regimens of the Italian Renaissance courts, and in particular of the Aragonese court of Naples, produced evidence of very high red meat consumption, attested also by the palaeonutritional data. Therefore, the alimentary ‘environment’ of the Neapolitan court of the 15th century, with the abundance of natural endogenous alkylating agents, can well explain the K-ras mutation causing the tumour that killed the Aragonese king over five centuries ago. Copyright © 1999 John Wiley & Sons, Ltd.

The polymorphism of (R,S) propranolol hydrochloride was investigated by differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), X-ray powder diffractometry (XRPD) and thermomicroscopy (HSM) coupled with FT-IR spectroscopy. Propranolol hydrochloride existed in three different crystalline forms, denoted as forms I, II and III, according to their decreasing melting temperatures. Modification II was the commercial product. The forms I and III were obtained by melting form II in different experimental conditions. Form III was obtained only by solidification of the melt in the presence of an alkali halide matrix (as a crystalline film on an alkali halide window or as powder dispersion in a KBr pellet). Forms I and II were also obtained by crystallization from 95% aqueous ethanol and acetone, respectively. The three forms were easily differentiated by their IR spectra in the 3400–2000 cm −1 range. The different crystalline structures of forms I and II were characterized by means of their X-ray powder diffraction patterns.

The effects of gamma irradiation on cascara bark were studied. Induced degradation products and modification in cascaroside ratio were investigated by a dedicated HPLC method. The presence of free radicals was evaluated by EPR technique. Both HPLC and EPR measurements were performed at different times up to four months after the irradiation process.

The development of a selective method for the separation and identification of amoxicillin sodium-related substances is described. It is based on reversed-phase liquid chromatography followed either by UV detection (LC–UV) or by mass spectrometry (LC–MS). Mass detection was carried out by an atmospheric pressure ionization source and ionspray interface. Flow injection analyses–MS gave positive-ion mass spectra exhibiting abundant peaks due to their protonated molecules without significant fragmentation. The protonated molecules were used for selected ion monitoring LC–MS analyses. The method allowed the resolution of 13 available potential impurities from amoxicillin and from each other. Its applicability to an MS detector also permits a rapid identification of the impurities in the lack of the corresponding reference substances.

Reports of cardiovascular diseases in ancient time are very rare since the material mainly consists of skeletal remains; therefore, these diagnoses can only be carried out indirectly, through the marks left on bones. Here we show a case of coarctation of the aorta diagnosed on bones. Aortic coarctation is a congenital disorder in which a portion of the aorta is narrowed to various extent. A collateral circulation system is enrolled to allow adequate compensation of the blood flow. Collateral vessels may become enlarged, producing a distinctive notching on the pleural surface of the ribs and on adjacent bones. Excavation of a sixth to fifth century B.C. Etruscan tomb revealed three funerary chambers (celle) housing 14 skeletal remains of adults. The ribs of one of the male skeleton showed "nail stroke" indentations. Detailed macroscopic examination enabled us to identify them as notching and led to the diagnosis of postductal aortic coarctation. Histological analysis of bone tissue from the notching areas excluded inflammatory and pathological erosive events, supporting the macroscopic diagnosis. The present paper is the first description of aortic coarctation in paleopathology.

The purpose of this report is to present the case of a 75‐year‐old male affected by right common femoral artery and abdominal aortic aneurysms. His clinical history was also characterised by post‐ischaemic cardiomyopathy, arterial hypertension, chronic respiratory disease and peripheral arterial disease. We performed two surgical procedures: right femoral aneurysmectomy and femoro‐femoral bypass and subsequently a femoro‐femoral crossover bypass plus right femoro‐popliteal bypass below the knee. The second operation became necessary in order to treat acute occlusion of the right iliac‐femoral arterial axis. The patient developed a progressive and aggressive lower limb post‐perfusion syndrome associated to frank peripheral oedema, myocardial stunning, reperfusion arrhythmias, renal failure and respiratory distress. Cutaneous alterations (oedema of the leg, mottled skin and cyanosis of the foot) were more specific compared with Doppler ultrasound that showed the presence of adequate blood flow in the early phase. On the basis of this experience and of pertinent literature, this study represents a challenge for the understanding of the exact mechanism of origin and progression of post‐reperfusion syndrome.

In the word-stem priming test, words are presented (e.g., MOTEL, PARADE), and later subjects are shown three-letter word stems (e.g., MOT, PAR) and asked to complete each stem with the first word that comes to mind. Word-stem priming, as well as other aspects of implicit memory, are intact in amnesic patients with medial temporal lesions. However, this form of priming has been shown to be impaired in patients with Alzheimer's disease, suggesting that damage to neocortical areas outside the medial temporal lobe contributes to impaired priming in these patients. To examine the role of posterior cortical areas on word-stem priming, we administered the test to patients with unilateral temporal-occipital lesions. Patients with temporal-occipital lesions exhibited significantly impaired priming on this test. The findings suggest a critical role of the inferior posterior neocortex in the expression of this form of implicit memory.

Objectives: (a) Evaluate the efficacy and duration of effect of lisdexamfetamine dimesylate (LDX) in adult ADHD. (b) Assess the reliability and validity of the Adult ADHD Medication Smoothness of Effect Scale (AMSES) and Adult ADHD Medication Rebound Scale (AMRS). Method: Adults ( N = 40) with ADHD were treated with LDX for up to 12 weeks. The primary efficacy measure was the ADHD Rating Scale (ADHD-RS). The psychometric properties of the AMSES and AMRS are analyzed and compared with the ADHD-RS, ADHD Self-Report Scale (ASRS) v1.1 Symptom Checklist, and Time-Sensitive ADHD Symptom Scale (TASS). Results: ADHD-RS scores were significantly improved with LDX. The AMSES and AMRS had high internal consistency and were correlated with the ADHD-RS, ASRS v1.1 Symptom Checklist, and TASS. Conclusion: LDX is effective in treating adult ADHD and has a smooth drug effect throughout the day with limited symptom rebound. The AMSES and AMRS are valid and reliable measures.

The ESR technique was tested as a tool to detect antibiotics irradiated for sterilization purposes. Thirteen different cephalosporins, each commercially available, were given a sterilization dose of 25 kGy and then studied by ESR. For 12 out of the 13 samples tested, a specific radiation-induced signal was detected whose time stability allows identification tests. For one cephalosporin (cefaclor), the same signal is present in the irradiated and unirradiated samples. However, identification is still possible due to the high radiation-induced radical concentration and favorable signal time stability.

The study aims to analyze retrospective results of extensive endovascular repair of the descending thoracic aorta with special attention to spinal cord malperfusion.From April 2002 through November 2011, 21 patients underwent stent-graft coverage of the thoracic aorta from the aortic arch at the origin of the left subclavian artery to the celiac trunk, 6 (mean age =72.3±8.1) for aneurysm disease, 13 (mean age =74.3±8.4) for type B aortic dissection and 2 (mean age =52.1±6.5) for aortic rupture. The mean of aortic diameter in cases with aneurysm disease was 7.1±1.6 cm and the causes of aortic rupture were post-traumatic and aneurysm pathology respectively. In all cases needing coverage of the left subclavian artery duplex ultrasonography and flowmetry were performed to evaluate patency and flow of both the vertebral arteries.Technical success was 100% with 0% in-hospital mortality. The left subclavian artery was crossed with the uncovered portion of the stent-graft in 11 cases (52.4%) and the covered segment in the other 10 patients (47.6%) without subclavian revascularization because no pre-operative hemodynamic alterations of vertebral arteries were revealed by duplex ultrasonography. The incidence of paraplegia was 9.5% in 2 patients who had prior abdominal aortic aneurysm repair: the first case with preoperative type B aortic dissection presented significant lower extremity paresis within 24 hours after the procedure and in the second patient with a large thoracic aneurysm the signs of paraplegia were evident 3 weeks after discharge from Hospital probably due to delayed occlusion of a major medullary artery. The cumulative survival rate after 1, 3 and 9 years was 91%, 81%, and 71%.The coverage of the entire thoracic aorta is an effective procedure with high probability of success. Spinal cord malperfusion remains a serious complication especially in patients with prior aortic surgery but if collateral blood supply is maintained the occlusion of intercostal arteries do not determine paraplegia or paraparesis. In order to consider acute or chronic occlusion of subclavian, lumbar or hypogastric arteries so preventing spinal cord ischemia, strong preoperative evaluation including analysis of previous surgery for abdominal aortic aneurysm repair and avoidance of T12 aortic segment coverage if feasible is mandatory.

The effects of gamna irradiation on cefuroxime and cefotaxime were studied. Degradation products and long-lived free radicals were investigated as a function of radiation dose. The formation of new impurities was evidenced by HPLC in both the compounds. A valuable increase of the pre-existent impurities, anti-isomer included, was found only in cefuroxime. ESR measurements put in evidence the presence of ganma radiation induced long-lived free radicals. Moreover, the influence of gamma irradiation on syn-anti isomerization was evaluated in comparison with the photoisomerization induced by ultraviolet light exposition on powder samples.

iIn a study by Beyene, Gilliss, and Lee (2007), 40to 48-year-old women, when questioned about what they considered “middle age,” identified 45 to 60 years as “middle-aged.” Many women, although they may no longer consider themselves “young,” don’t consider themselves “old,” either. Rather, they look at their mothers and describe them as old (Im, Liu, Dormaire, & Chee, 2008). According to Shilling (2011), “Sixty is the new forty” is a common refrain and 45 no longer feels “old.” While it’s great to be young at heart, it’s still important for women to be aware of the health issues they may encounter as they enter middle age. Yet, many may not be thinking about the approach of menopause and its concomitant health changes until noticeable physical alterations occur (Im et al., 2008; Weismiller, 2009). Perimenopause and Menopause Menopause is a natural and normal part of a woman’s life, a transition to the part of life when she is no longer able to bear children. For most women, perimenopause, or the time period from the onset of menopausal signs and symptoms through the cessation of menses for greater than 1 year, usually begins around age 47, and is complete by age 55 (Weismiller, 2009; Zender & Olshansky, 2009). Many women see this as a positive time in their lives, with decreasing worries about contraception or menses; however, other women may see it as an end to their unique Approaching Menopause (But Not There Yet!)

The effects of gamma and electron beam irradiation on cephradine were studied as a function of dose. In particular, degradation products and free radicals induced by radiation on samples with different moisture content were investigated. The influence of daylight on the kinetics of the degradation processes was also evaluated.

Summary The quality of liquid oxygen in domiciliary medical systems used for oxygen therapy was investigated during the emptying cycle under simulated breathing conditions. The increase in the levels of contaminants during the use of these systems was evaluated by gas chromatography and two sampling methods. The quality of liquid oxygen from storage tanks located in hospitals and in the production or in distribution plants was also investigated.

Study objective To describe clinical effects and outcome after acute quetiapine overdose in adults and compare these with overdose by all other antipsychotic drugs as a group. Methods We performed a 5-year (2002 to 2006) retrospective case series by chart review of the California Poison Control System database for adult patients with acute ingestion of quetiapine. Patients with coingestants were excluded. Symptoms, signs, and medical outcomes were extracted from the database and also by direct chart review for some variables (QRS- and QT-interval prolongation, torsades de pointes). Results We found 945 cases meeting criteria for analysis. Intentional ingestions accounted for 87% of cases. Patient ages ranged from 18 to 84 years, with a median of 35 years. There were 3 deaths, all of whom had coma, tachycardia, and respiratory depression requiring ventilatory support. Clinical manifestations included drowsiness (76%), coma (10%), seizures (2%), tachycardia (56%), hypotension (18%), and respiratory depression (5%). There were insufficient data to determine the incidence of QRS or QT prolongation in our study group, but only 2 patients were reported to have ventricular tachycardia and neither was described as having torsades de pointes. Compared with overdose by all other antipsychotic agents as a group, quetiapine was more likely to cause hypotension (odds ratio [OR] 2.05; 95% confidence interval [CI] 1.52 to 2.76), coma (OR 2.16; 95% CI 1.46 to 3.20), and respiratory depression (OR 2.49; 95% CI 1.40 to 4.41); require tracheal intubation (OR 1.92; 95% CI 1.41 to 2.61); and result in death or a major medical outcome (OR 2.62; 95% CI 1.78 to 3.85). Conclusion Consequences of acute quetiapine overdose included coma, respiratory depression, and hypotension, and these complications were more common compared with overdose by all other antipsychotic agents as a group.