Cardiopulmonary exercise testing for personalized job reintegration after acute cardiovascular attacks: a pilot cross-sectional study

Background:Cardiovascular diseases (CVD), particularly the ischemic heart disease, are a growing public health issue. In addition, the return to work after an acute cardiovascular attack represents a complex challenge.Objectives:To evaluate utility and safety of cardiopulmonary exercise testing (CPET), particularly performed “on site”, to promote a return to work in line with the residual working capacity.Methods:Fifty-nine workers affected by a major cardiovascular event, aged 18-63 years, have been enrolled between 2015 and 2018. All the patients underwent a CPET in outpatient clinic. Eleven workers also underwent the “on site” CPET, recorded during their working activities.Results:Outpatient clinic CPET outcomes (i.e. normal, mild impairment or moderate/severe impairment of cardiopulmonary function) were associated with the subjective perception of workers’ health status after returning to work. The “on site” CPET was found to be safe and reliable to promote a personalized return to work of patients. In 7 out of 11 patients, the values of O₂ consumption (VO₂) during the working activity were higher than 40% of VO₂ max as obtained from laboratory CPET.Conclusions:This study provides evidence for safety and usefulness of “on site” CPET for a personalized statement of fitness for work. This may facilitate the job retention of patients characterized by a high risk of unnecessary job loss. The use of CPET represents a first step of energy expenditure evaluation associated with specific working tasks.Key words: Acute coronary syndrome, cardiopulmonary exercise testing, return to work     

A study of periapical lesions correlating the presence of a radiopaque lamina with histological findings.

OBJECTIVE: To compare the presence or absence of a radiopaque lamina of 60 human periapical lesions with the histological findings from a case study in dental practice. STUDY DESIGN: Paralleling radiographs were taken of 60 teeth with periapical radiolucencies. The periapical radiographs were scanned, and standardized images were evaluated on a computer screen for the presence or absence of a radiopaque lamina by 2 calibrated observers according to agreed criteria. The serially sectioned histological specimens were obtained from the extraction of 13 endodontically treated teeth and 27 nontreated teeth, as well as 20 post-treatment teeth with apical periodontitis removed during periapical surgical procedure; the specimens were classified according to agreed criteria. The findings of the 2 evaluations were compared. RESULTS: Out of 57 electronic images that could be interpreted, 10 lesions had a radiopaque lamina, but of these only 3 were histologically diagnosed as cysts, while 7 were granulomas or abscesses. Out of 47 lesions without a radiopaque lamina, 40 were histologically diagnosed as granulomas or abscesses, while 7 were cysts. CONCLUSIONS: The diagnosis of periapical lesions cannot be made on the basis of the presence or absence of a radiopaque lamina, but requires histological examination of serial sections.     

Gonadotropin-releasing hormone antagonists increase follicular fluid insulin-like growth factor-I and vascular endothelial growth factor during ovarian stimulation cycles.

The aim of the present study was to investigate the effect of gonadotropin-releasing hormone (GnRH) antagonists (GnRH-ant) on follicular fluid (FF) insulin-like growth factor-I (IGF-I) and FF vascular endothelial growth factor (VEGF) levels. Sixty women undergoing assisted reproduction were randomized and assigned to two different GnRH analog regimens: GnRH agonist (GnRH-a) and GnRH-ant. FF VEGF and FF IGF-I concentrations were significantly increased in the patients treated with GnRH-ant (p < 0.001). In the same patients we observed a statistically significant reduction in serum luteinizing hormone (LH) and estradiol (E2) levels (p < 0.001 and p < 0.05, respectively), FF E2 and FF androstenedione levels (p < 0.05 and p < 0.001, respectively), as well as a reduction in the number of pregnancies although this was not statistically significant. In the GnRH-ant group, FF VEGF levels were positively correlated with FF IGF-I levels, and both were negatively correlated with serum LH levels. The increase in FF IGF-I and FF VEGF levels in women treated with GnRH-ant could be explained by a deleterious follicular environment in response to profound suppression of LH and E2 levels.     

Indices of surgical site infection risk and prediction of other adverse outcomes during hospitalization.

OBJECTIVE: To assess which adverse postsurgical outcomes are best predicted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance system (NNIS) index. DESIGN: Prospective cohort study. SETTING: The service of general surgery at a tertiary care hospital. PATIENTS: A consecutive series of patients hospitalized for more than 1 day (n=2,989). RESULTS: The outcome best predicted by the SENIC and NNIS indices was assessed by estimating the area under the receiver operating characteristic (ROC) curve. The areas under the ROC curves for nosocomial infection and in-hospital death were higher for the NNIS index than they were for the SENIC index (P<.05). The NNIS index predicted in-hospital death better than it predicted surgical site infection (area under the ROC curve+/-SE, 0.836+/-0.022 vs 0.689+/-0.017; P=.001). CONCLUSIONS: The NNIS index is superior to the SENIC index for all adverse postsurgical outcomes. Its ability to predict in-hospital mortality is clearly better than its ability to predict surgical site infection.     

Microbial transformation of isoprenoid systems by means of fungi of Zoophthora genus — Microbial transformation of compounds with α-campholenic system by means of fungus Zoophthora (Neopandora) sp.

Unsaturated ketones ( 4 and 10 ) and epoxides ( 2–3 and 8–9 ) were the main products of biotransformation performed by means of Zoophthora (Neopandora) phyllobii. Enantiospecificity of both reactions leading to these compounds strongly depends on the distance of reacting fragment of molecule from the chiral center at C-1′.     

Massive intratubular hemorrhage with herniations into renal veins: report of a case

A 24-year-old man had unilateral gross hematuria that required nephrectomy. Pathological examination revealed massive intratubular hemorrhage and frequent deposition of an amorphous and homogeneous material positive for periodic acid, Schiff stain in the corticomedullary junction. This substance had the characteristics of Tamm-Horsfall protein and frequently herniated into the lumen of thin-walled veins of arcuate size. There was no apparent cause for the bleeding. To the best of our knowledge this is the third reported case with these peculiar findings and no apparent cause. We discuss some hypotheses as to the etiopathogenesis of this rare and intriguing condition.