Search

Primary Nursing (PN) is a model of care delivery which is described to favor patient participation, as a Primary Nurse is responsible for coordinating all aspects of care including discharge planning. The purpose of this paper is to explore patient-nurse interactions in a rehabilitation clinic in which PN is used. Twenty-five interactions of video-recorded data involving 12 patients with their primary nurse were included in this paper and analyzed using conversation analysis, an inductive data-driven approach. Our findings suggest that nurses use two different communicative styles – a “reciprocal” or a “individual” perspective – when discussing discharge decisions with patients. While the “reciprocal” style is a more collaborative approach, the “individual” communicative practice is more unilateral. Making those different approaches explicit might lead to refinement of Primary Nursing theories. [ABSTRACT FROM AUTHOR]

The first projects relating to levels of Cd and Hg on marine biota and sediments from Terra Nova Bay (Ross Sea––Antarctica) and their bioaccumulation and biomagnification in this trophic web have been carried out by research programmes pertaining to the Italian Antarctic Research Program (PNRA) since 1989.Making use of this data, and checking the same metals after 10 years thanks to the samples stored in the BCAA, we have looked for the levels of Cd and Hg in a coastal marine ecosystem of Terra Nova Bay, and have proposed using some organisms to monitor the levels of these two heavy metals in this environment where the Italian Base is located, using the data determinate in this work as background levels.In our work, the amount of Hg and Cd concentrations have been determined in biota from the inner shelf of Terra Nova Bay (Adamussium colbecki, Laternula elliptica, Odontaster validus, Sterechinus neumayeri, Trematomus bernacchii, Iridaea cordata, Phyllophora antarctica, Parborlasia corrugatus), and in two different size fractions of sieved marine sediments (<2000 μm and <63 μm).To widen the distribution of Cd and Hg in this ecosystem we have also investigated the fraction of these metals bound to the labile phase of the marine sediments, and their presence in the particulate matter found in pack-ice cores, recent snow, water column and sea microlayer. [Copyright &y& Elsevier]

Abstract: Background: We report our results with the use of corticosteroid-free immunosuppression after pediatric liver transplantation, evaluating the efficiency and safety of this protocol in the early posttransplantation period. Patients and Methods: From July 2003 to October 2005, 34 liver transplantations were performed in 32 pediatric patients (19 boys, 13 girls) at our institution. Recipient median age was 5 years (range, 0.2–14 years), and median body weight was 10 kg (range, 4–49 kg). Twenty-seven patients received a graft from in situ split liver transplantation, 5 a whole graft. Twenty-nine children (90%) received an immunosuppressive therapy based on methylprednisolone IV bolus at reperfusion (10 mg/kg) plus tacrolimus given at an initial dose of 0.08 mg/kg/d and then adjusted to obtain whole blood trough levels of 10 to 15 ng/mL during the first 3 months and 5 to 10 ng/mL after the 3rd month; basiliximab was given on postoperative days 0 and 4. Biopsy-proven acute rejection episodes were treated by methylprednisone IV boluses. Results: After a median follow-up of 9 months (range, 1–27 months), the overall patient survival rate was 84% and graft survival rate was 79%. Three children (9%) died after their transplantations. Three (9%) experienced episodes of biopsy-proven acute rejection, always treated with IV steroid boluses. Mean RAI score was 4. One patient experienced PTLD that resolved with temporary reduction of immunosuppression. Cytomegalovirus infection rate was 14%. Sepsis occurred in 2 cases (6%). Conclusions: Initial results with a steroid-free immunosuppressive protocol are encouraging, with low rates of acute rejection and infectious complications as in steroid-based protocols. [Copyright &y& Elsevier]

More than 100 filamentous fungi strains, mostly ascomycetes and zygomycetes from different phyla, were screened for the ability to convert deoxycholic acid (DCA) to valuable bile acid derivatives. Along with 11 molds which fully degraded DCA, several strains were revealed capable of producing cholic acid, ursocholic acid, 12-keto-lithocholic acid (12-keto-LCA), 3-keto-DCA, 15β-hydroxy-DCA and 15β-hydroxy-12-oxo-LCA as major products from DCA. The last metabolite was found to be a new compound. The ability to catalyze the introduction of a hydroxyl group at the 7(α/β)-positions of the DCA molecule was shown for 32 strains with the highest 7β-hydroxylase activity level for Fusarium merismoides VKM F-2310. Curvularia lunata VKM F-644 exhibited 12α-hydroxysteroid dehydrogenase activity and formed 12-keto-LCA from DCA. Acremonium rutilum VKM F-2853 and Neurospora crassa VKM F-875 produced 15β-hydroxy-DCA and 15β-hydroxy-12-oxo-LCA, respectively, as major products from DCA, as confirmed by MS and NMR analyses. For most of the positive strains, the described DCA-transforming activity was unreported to date. The presented results expand the knowledge on bile acid metabolism by filamentous fungi, and might be suitable for preparative-scale exploitation aimed at the production of marketed bile acids. [ABSTRACT FROM AUTHOR]

Abstract: Selected actinobacteria and filamentous fungi of different taxonomy were screened for the ability to carry out regio- and stereospecific hydroxylation of lithocholic acid (LCA) at position 7β. The production of ursodeoxycholic acid (UDCA) was for the first time shown for the fungal strains of Bipolaris, Gibberella, Cunninghamella and Curvularia, as well as for isolated actinobacterial strains of Pseudonocardia, Saccharothrix, Amycolatopsis, Lentzea, Saccharopolyspora and Nocardia genera. Along with UDCA, chenodeoxycholic (CDCA), deoxycholic (DCA), cholic (CA), 7-ketodeoxycholic and 3-ketodeoxycholic acids were detected amongst the metabolites by some strains. A strain of Gibberella zeae VKM F-2600 expressed high level of 7β-hydroxylating activity towards LCA. Under optimized conditions, the yield of UDCA reached 90% at 1g/L of LCA and up to 60% at a 8-fold increased substrate loading. The accumulation of the major by-product, 3-keto UDCA, was limited by using selected biotransformation media. [Copyright &y& Elsevier]

Modulation of atrioventricular (AV) node conduction and radiofrequency ablation of AV junction are alternative approaches to control ventricular rate in drug refractory atrial fibrillation (AF). In 2 centers, 120 patients were treated either with AV junction ablation (center 1, group 1, 60 patients [30 men, aged 64 +/- 11 years], paroxysmal AF in 24 patients) or with modulation (group 2, 60 patients [32 men, aged 58 +/- 12 years], paroxysmal AF in 43 patients). In group 1, complete AV block was achieved in all patients. In group 2, the procedure was performed in sinus rhythm (30 patients), prolonging the Wenckebach cycle length from 328 +/- 85 to 466 +/- 80 ms (p <0.01) or during AF (30 patients), decreasing ventricular rate from 178 +/- 35 to 96 +/- 35 beats/min (p <0.01), and to <100 beats/min in 17 patients (61%). Complete AV block was induced in 9 of 60 patients (15%). In groups 1 and 2, at a follow-up of 27 +/- 7 and 26 +/- 6 months, there were 2 deaths (1 cardiac, 1 sudden death) and 1 death for end-stage heart failure, respectively. Hospital readmissions decreased from 3.2 to 0.2 and from 4.2 to 0.2/year; late AF recurrences at of >120 beats/min were documented in 6% and 12%, respectively. Symptom score analysis including effort and rest dyspnea, exercise intolerance, weakness, and palpitation showed a significant improvement in both treatment groups, when acutely effective, in patients with paroxysmal and/or chronic AF. In conclusion, ablation of the AV junction shows a higher acute success rate compared with modulation of the AV node conduction in patients with drug refractory AF. Depending on the acute success, both approaches therefore were similarly effective in achieving long-term ventricular rate control and symptom score improvement. [ABSTRACT FROM AUTHOR]

Abstract: Background: We report our initial experience with in situ split liver transplantation (SLT) for adult and pediatric patients. Patients and Methods: From June 2003 to August 2005, 177 liver transplantations in 165 patients, 133 adults (81%) and 32 children (19%), were performed at our institution. Over this period, 45 liver transplantations (25%) were performed with an in situ split liver technique in 44 patients: 17 (39%) were adults and 27 (61%) children. All of the adult split liver recipients were transplanted with an extended right graft (ERG; segments I + IV–VIII), while pediatric recipients received in 23 cases a left lateral segment (LLS; segments II–III) and in 4 cases an ERG from a pediatric donor. The 45 split liver grafts (21 ERGs and 24 LLSs) were generated from 35 donors. In 10 cases we used both grafts generated with an in situ split procedure to transplant our patients, while in 25 cases the procurement procedure was performed in collaboration with other transplant centers. Results: After a median follow-up of 9 months (range, 1–27 months), the overall patient survival rate was 88% for adult patients and 82% for pediatric patients. Graft survivals were 88% and 79%, respectively. Two adult patients (12%) died from sepsis in the early postoperative period. Five children (18%) died after their transplantations. Only one pediatric recipient (2%) of primary SLT underwent retransplantation. Vascular complications were absent in adult recipients, whereas 4 arterial (14%) and 4 venous (14%) complications developed in the pediatric population. The incidence of biliary complications was 23% in adult and 18% in pediatric recipients. Conclusions: The use of in situ SLT for adult and pediatric populations allowed us to expand the cadaveric donor pool, significantly eliminating pediatric waiting list mortality without penalizing the adult population. [Copyright &y& Elsevier]

Abstract: We reviewed the clinical data of 30 children-hospitalized for acute liver failure in the last 6 years. Ten patients were not listed for liver transplantation OLTX. Their clinical conditions gradually improved and they are all alive without deficit. Among 20 patients listed, 15 underwent urgent OLTX. Two children died on the waiting list and three were suspended from waiting list after few days because of improvement. Survival according to age class was analyzed dividing the patients into two groups: A, age 1 year or less versus B, age between 1 and 16 years. The patient survival was 86% at 6 months and 61% both at 1 and 2 years. Survival at 6 months and 1 and 2 years was 88%, 67%, and 45% for the patients in group A and 83%, 83%, and 83% for the patients in group B (P = NS). Observing graft-to-recipient weight ratio and donor-to-recipient weight ratio most patients received an optimal sized graft. The split-liver technique is considered the preferred method of liver transplantation even in the pediatric patients with acute liver failure; especially in the setting of a cooperative system in which all livers that are suitable for split-liver transplantation are shared between centers. In order to have the best chance for survival, children with acute liver failure should be referred as soon as possible to an highly specialized pediatric liver transplantation center that can offer all the treatment modalities that are currently available. [Copyright &y& Elsevier]

Abstract: We report a case of minimally invasive nephrectomy of a kidney transplanted into the abdominal cavity in a child. A 15-year-old girl underwent transplantation with a cadaveric donor kidney due to congenital pyelonephritis, vesicoureteral reflux, and secondary bladder atrophy. The transplant was complicated by hyperacute rejection, cytomegalovirus infection, and anastomotic stenosis of the Bricker neobladder. After recurrent urinary tract infections, the patient was reintroduced to hemodialysis in 2010. After pneumo-peritoneum, we placed 2 10-mm trocars in the hypochondrium and left side and 2 5-mm in the left iliac fossa and right upper quadrant. The transplanted kidney was skeletonized, the artery and vein were cut to the end-to-side anastomoses to the juxta-renal aorta and cava using an automatic 35-mm, stapler, and the ureter was dissected and closed with clips. Via a Pfannestiel minilaparotomy we extracted the allograft. The patient was discharged on the third postoperative day. After 4 months of follow-up, she is alive an on dialysis. Laparoscopic nephrectomy of a kidney transplanted into the abdominal cavity is feasible and safe in centers with skilled minimally invasive techniques. [Copyright &y& Elsevier]

Abstract: Biliary atresia (BA) represents the most frequent indication for liver transplantation (OLTX) in the pediatric population. The aim of this paper was to present a series collected over the last 7 years from October 1997 through July 2004, including 260 pediatric OLTX in 231 patients. BA was the indication in 137 patients. There were 69 boys and 68 girls of mean weight 10.68 kg and median age 0.9 years. As a primary transplant, 99 patients received a LLS graft; 27 a whole graft; four a I+IV-VIII segment, and two a I-IV segment. Mean follow up was 1047 days (range, 1¿2496 day). Infections were diagnosed in 45 patients, vascular complications in 27 patients. Surgical complications that required reintervention occurred in 25 patients. In 41 cases biliary complications occurred, 11 requiring reintervention. 16 patients were retransplanted. In two cases another re-OLTx was performed. Currently 126 patients are alive, showing an actuarial 1 year survival of 92% and 5 year 91%, with actuarial graft survivals of 85% at 1 year and 82% at 3 and 5 years. Our results confirm the effectiveness of OLTx for the treatment of children with BA and a failed Kasai procedure. Split liver grafts represent an excellent organ supply for these patients, achieving optimal results with no mortality on the waiting list. [Copyright &y& Elsevier]

The inability to stand without orthostatic hypotension is the typical disabling clinical symptom of both Postural Tachicardia Syndrome (POTS) and Orthostatic Intolerance (OI). The increase of sinus heart rate of 30 beats/min or greater occurring within 10 min of head-up tilt test or standing, or a heart rate while upright of >120 beats/min. discriminates between the two conditions. To verify if others criteria, beside the difference in heart rate increase, can distinguish the two groups, we analyzed the cardiovascular responses during active standing and head – up tilt test. We analyzed 10 patients with POTS and 10 with OI. Power spectral analysis of blood pressure and heart rate variability, in resting condition and during a period of 30 min of head – up tilt test to 60°, was performed. Both clinical conditions were compared with each other and with a control group using the Student t test. During the head – up tilt both groups of patients showed a marked and comparable increase of LF-RRI and LF/HF ratio in the power spectrum of R–R interval compared to the baseline. This could suggest the hypothesis of OI as a condition preceding POTS. [ABSTRACT FROM AUTHOR]

In spinal cord injury both the level and the extension of the lesions have been related to different response to tilting in Low Frequency (LF) and High Frequency (HF) oscillations of heart rate. To understand the role of sympatho–vagal interaction in such patients, we tried to evaluate, using the LF/HF ratio, the residual possibility in maintaining the cardiovascular homeostasis. 9 subjects with different outcome of traumatic (4) and inflammatory (5) spinal cord involvement, with lesion between C6 and T10, were investigated with power spectral analysis of the blood pressure and heart rate variability in resting condition and during a period of head – up tilt test. The difference between the two conditions was tested using the Wilcoxon signed rank test. In patients with complete ASIA A lesion, the relatively preserved LF activity in resting condition did not increase during tilting, with a parallel decrease of LF/HF ratio. In patients with incomplete lesion (ASIA B, C, D), the LF power of R–R interval showed an inverse relation with the level of the lesion. The LF/HF ratio was partially maintained due to the concomitant adapting HF activity permitting an efficient sympatho–vagal balance. [Copyright &y& Elsevier]