Introduction
Persons with haemophilia (PWH) experience recurrent joint bleeding which leads from early synovitis to irreversible joint damage. Pain strongly affects patients’ quality of life, as PWH ...suffer from acute pain associated with haemarthroses and chronic pain due to arthritic and degenerative complications.
Aim
To investigate pain issues among PWH and their treaters in Italy.
Methods
Persons with haemophilia and specialist physicians responded to a survey focused on pain characteristics, assessment, and management by phone call and online, respectively.
Results
One hundred and nineteen patients (76% severe haemophilia, 61% ≥18 years) and 44 physicians were involved. Pain was reported by 61% of PWH; among those who did not experience pain, 70% were children on prophylaxis. Patients described pain as chronic (71%), acute (69%) or postoperative (8%), and rated it as severe in 65% of cases. Clinicians reported lower percentages of patients with pain (46%), classified as chronic (58%), acute (33%) or postoperative (21%), half using specific scales. Pain was systematically investigated by treaters according to 36% of patients. Paracetamol was largely the most prescribed first‐line pain therapy (89%), as well the most employed analgesic by PWH (51%), who also used non‐steroidal anti‐inflammatory drugs (24%), cyclo‐oxygenase‐2 inhibitors (21%) or opioids (26%). To manage pain, 61% of clinicians stated to collaborate with other specialists. Physiotherapy was often suggested but less frequently used by PWH.
Conclusions
Pain is under‐recognized and unsatisfactorily addressed by haemophilia treatment centre (HTC) clinicians, with discrepant management compared to PWH responses. Education in systematic pain assessment and multidisciplinary treatment and development of management guidelines are highly needed.
Since many years the ESA Research and Service Support (RSS) service provides resources to support Earth Observation (EO) data exploitation. Significant value has been delivered in these years to EO ...researchers in terms of cost, time and resource saving, thus enabling enhanced scientific productivity. In the new Sentinel era, recently started with the launch of Sentinel-1 in April 2014, data volume and processing requirements will be more challenging than before. The EO scientific community accessing and using RSS resources will therefore experience even greater benefits in terms of cost, time and resources savings, for activities related to data procurement, handling, storage, access, and processing.
In this letter, we propose an algorithm to detect the presence of forest fires using data from both geostationary and polar-orbiting satellites. The very frequent acquisitions of the Spinning ...Enhanced Visible and Infrared Imager radiometer placed onboard the Meteosat Second Generation-9 satellite are used as main source for the algorithm, while the MEdium Resolution Imaging Spectrometer global vegetation index and the Advanced Along-Track Scanning Radiometer measurements are used to enhance the reliability of the detection. The problem is approached in a ¿global¿ way, providing the basis for an automated system that is not dependent on the local area properties. In cooperation with the Centre de Suivi E¿cologique (Dakar, Senegal), the proposed algorithm was implemented in a ¿Multisource Fire Risk Management System¿ for the Senegal area, as briefly described in this letter. A field campaign of one week was carried out in order to perform a validation of the system's detections, showing a good agreement with the fire coordinates measured on the ground. Furthermore, a consistency check was performed using data from the Moderate Resolution Imaging Spectroradiometer (MODIS) Rapid Response System, showing that more than 76% of high-confidence MODIS events are detected by the algorithm.
Summary
The low‐density lipoprotein receptor‐related protein 1 (
LRP
1) is an ubiquitously expressed endocytic receptor that, among its several functions, is involved in the catabolism of coagulation ...factor
VIII
(
FVIII
) and in the regulation of its plasma concentrations. Although
LRP
1/
CD
91 polymorphisms have been associated with increased
FVIII
levels and a consequent thrombotic risk, no data are available on
LRP
1/
CD
91 expression in patients with inherited
FVIII
deficiency. With the aim of elucidating this issue, 45 consecutive patients with haemophilia A (
HA
) (18 severe, 5 moderate and 22 mild
HA
) were enrolled in this cross‐sectional, single‐centre survey. The
LRP
1/
CD
91 mean fluorescence intensity (
MFI
) in monocytes from
HA
patients was significantly higher than that detected in 90 healthy blood donors (105 vs. 67,
P
< 0.001). This over‐expression was independent of hepatitis C virus infection status and varied according to the severity of the haemophilia, being higher in patients with more severe
FVIII
deficiency. In conclusion, our study documents for the first time that
LRP
1/
CD
91 is over‐expressed on monocytes from
HA
patients, with the intensity of expression varying according to the severity of the
FVIII
deficiency. Further studies are needed to assess the clinical implications of these findings.
The experience gained during the last 5 years in the study of 36 male workers exposed to hard metal dusts (10 engaged in mixing, 12 in presintering, three in sintering and 11 in grinding) is ...presented. The mean age was 33.2 years (S.D., 11.8) and the mean number of years of exposure was 9.4 (S.D., 7.6). All subjects received a physical examination, chest X-rays, pulmonary function test (VC, FEV1, expiratory flows, RV, DLCO, and metacholine bronchial provocation test), skin tests, bronchoalveolar lavage (BAL) and determination of trace metals in BAL, blood, urine, pubic hair and toe nails. Two cases of bronchial asthma, six cases of interstitial lung disease and one case with both disorders were identified; eight of these cases presented at BAL signs of alveolitis with different cytologic features. Among the other 27 asymptomatic subjects, two showed an aspecific bronchial hyperreactivity, four showed a reduced DLCO, 12 showed an inverted ratio of CD4/CD8 lymphocytes in BAL without signs of alveolitis while one subject presented both an aspecific bronchial reactivity and a reduced DLCO. The presence of aspecific bronchial hyperreactivity in asymptomatic subjects might represent a preclinical indicator of a possible evolution towards bronchial asthma. An altered DLCO, alone or associated with an inverted CD4/CD8 ratio of BAL lymphocytes, might constitute an early sign of a possible evolution towards interstitial lung disease. The association of aspecific bronchial reactivity and reduced DLCO might indicate the possible evolution towards a mixed form.
This paper presents the integration of the advanced Differential SAR Interferometry (DInSAR) algorithm referred to as Parallel Small BAseline Subset (P-SBAS) within the ESA's Grid Processing on ...Demand (G-POD) environment in the framework of ESA Geohazards Exploitation Platform (GEP). The aim of this activity is to set up a scientific service that allows, in unsupervised manner, the generation of SBAS-DInSAR products, such as surface mean deformation velocity map and the corresponding time series. In particular, such a web tool is aimed at efficiently exploit the huge ESA's SAR data archives (ERS and ENVISAT), giving a support to scientific users, especially those non-expert of SAR data processing, for interferometric analysis in a short time frame.
In the second half of the seventies, at the same time as the control of silicosis was achieved thanks to pathogenetic and preventive developments, the major efforts of the Clinica del Lavoro in the ...pneumological field were focused on studying dose-response relationship in asbestos-exposed subjects. Thus for the first time biological indicators (and not radiological ones) were mentioned for asbestos diseases. Bronchoalveolar lavage (BAL) allowed to compare an internal dose indicator (number of bodies/ml) and schlerogenous effect indicators (dose-response). Our experience over nearly 20 years for exposure assessment in asbestos-related diseases, based on over 500 cases has produced the following results: parenchymial asbestosis is dose-dependent while pleural plaques are dose-independent; epidemiologic data on existence of asbestos resistant subjects were confirmed; asbestos bodies proved to persist in alveolar cavities for several decades. At present, with the ban of asbestos and the increase in forensic medicine cases regarding past asbestos exposures, our Department demonstrated the importance of asbestos body counting in BAL as an objective indicator of asbestos exposure. Besides the asbestos issue, two less frequent work-related diseases were studied and in this regard bronchoalveolar lavage proved to be a substantial diagnostic tool, sometimes even decisive: these were hard metal disease and hypersensitive pneumonitis. In subjects exposed to hard metals, our experience showed the presence of a large lymphocytic alveolitis with CD4+/CD8+ reverse ratio for bronchial asthma and macrophagic-eosinophylic alveolitis characterized by several "bizarre" giant cells in the case of interstitial disease. In extrinsic allergic alveolitis, we noted the presence of a large lymphocytic alveolitis mostly with CD4+/CD8+ reverse ratio, persisting also during clinical remission of the disease.
This controlled, completely randomized trial was designed to compare the efficacy and safety of tramadol and pentazocine in the treatment of postoperative pain. A total of 50 adults were admitted (31 ...males, 19 females, mean age 48 years) to undergo hemorrhoidectomy or traumatological or abdominal surgery. Following a randomization list, each patient was given one ampul of tramadol (100 mg/2 mL) or pentazocine (30 mg/mL) by intramuscular injection at 8-h intervals for 3 days. Efficacy was assessed on both the basis of severity of pain (rated using a visual analog scale in the 6th h after the first injection and during the 3 days of treatment), and quality of sleep (rated using a five-point scale). Local reactions at the injection site (pain, skin reactions) were also assessed, as were systemic reactions (vital parameters, blood and biochemistry tests), and any untoward events were reported. Both drugs had good antalgic activity, significantly relieving pain in the 3 days of treatment (p < 0.01 from baseline). The first dose of tramadol was significantly more effective than pentazocine after the 1st h and throughout the subsequent 5 h. Final judgments on efficacy and acceptability were in favor of tramadol (p < 0.01 from pentazocine). Local and systemic safety were good, with no reactions at the injection site and no changes in vital parameters or laboratory findings. No patient reported any adverse reactions.
We investigated the expression of P-glycoprotein (P-gp) in 50 adults with de novo acute myeloid leukemia (AML) at the initial diagnosis in order to further define the relationship between the ...presence of P-gp on leukemic cells and the efficacy of two different anthracycline drugs, Daunorubicin (DNR) and Idarubicin (IRR), in terms of remission, induction and survival. We found that 30 (60%) of the 50 patients were negative for P-gp expression (group 1) and 20 patients (40%) were positive (group 2) for P-gp expression by MRK16MoAb using a cut of 10% positive cells. Among the 50 patients, 35 (70%) obtained complete remission (CR); depending on P-gp expression the CR rate was 80% for group 1 and 45% for group 2 (p < 0.005). The median duration of overall survival (OS) was 20 months for patients in group 1, compared to 10 months for patients in group 2 (p < 0.005). Regarding the anthracycline used, no difference in CR has been observed in patients of group 1 (75% CTR with DNR versus 90% CR with IDR); on the contrary in group 2 we observed 40% CR with DNR versus 70% CR with IDR (p < 0.005). No significant difference has been achieved in group 1 terms of median duration of overall survival between DNR and IDR regimen; on the contrary the median duration of OS in patients of group 2 treated with IDR regimen was significantly longer than DNR regimen (p < 0.005). These results confirm the prognostic value of P-gp expression in AML at diagnosis and we suggest that Idarubicin could be a valid anthracycline drug for reversing multidrug resistance.
Subclinical hypothyroidism is a condition characterized by increased levels of thyroid-stimulating hormone (TSH) associated with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). ...The exact prevalence of this condition in Italy is not known. The aim of this study was to assess the presence of subclinical hypothyroidism in 1001 subjects living in the Milan area (age 17-89) and apparently free from thyroid pathology. This sample which had applied to a large laboratory centre (Centro Diagnostico Italiano, Milano) for a routine check-up was seen from April to July 1996. A serum TSH assay was performed using a highly sensitive immunoenzymatic method, while an FT3 and FT4 assay was performed by means of a radioimmunologic method using commercial kits. The prevalence of subclinical hypothyroidism in the total population proved to be 4.7% (95% CI-Confidence Interval: 3.4-6.0). Sex stratification showed a prevalence of 6.1% in females and 3.4% in males. Prevalence in patients up to 65 was 4.2%. This value increased up to 8.0% in subjects over 65. By combining these variables, in females >65 prevalence increased to 11.3%. Overall, symptoms typical of overt hypothyroidism were found in 58.3% of patients suffering from subclinical hypothyroidism and in 39.9% of healthy subjects (p<0.02). The results of this study show that there is a significant presence (about 5%) of subclinical hypothyroidism in this population and that its frequency is more than doubled in women over 65. Early treatment might reduce the progression to overt hypothyroidism. The benefits of such a procedure were recently suggested by a decision making modelling approach applied to the Italian environment.
