Transvaginal ultrasound predicts delayed response to chemotherapy and drug resistance in stage I low-risk trophoblastic neoplasia

OBJECTIVES

Methotrexate (MTX) resistance is defined on the basis of the human chorionic gonadotropin (hCG) curve. The aim of this study was to identify low-risk non-metastatic patients with gestational trophoblastic neoplasia (GTN) who can achieve resolution by continuing MTX treatment despite a transient hCG plateau.

METHODS

Before starting chemotherapy, 24 patients with FIGO Stage I GTN underwent transvaginal ultrasonography with power Doppler in order to identify myometrial lesions (areas of increased echogenicity and increased power Doppler signal). Ultrasound response to chemotherapy was defined when myometrial lesions decreased in echogenicity, Doppler signal or size. When ultrasound response occurred, despite chemoresistance defined by hCG values, MTX treatment was continued.

RESULTS

MTX was continued in three out of seven chemoresistant patients because ultrasound suggested response to MTX. All three of these patients achieved a complete response, thus nearly halving the MTX-resistance rate.

CONCLUSION

Among patients who are candidates for second-line treatment on the basis of hCG, ultrasound may identify those in whom further MTX administration can induce a delayed complete response.

Dermatology Life Quality Index score in vitiligo patients: a pilot study among young Italian males

AIM

A negative impact on vitiligo patients in terms of quality of life (QoL) has been suggested. The aim of this report was to study the QoL in a sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire.

METHODS

A sample of forty seven vitiligo subjects, identified among 34,740 potential conscripts resident in southern Italy underwent the Italian version of the DLQI questionnaire.

RESULTS

The median total DLQI score was 1 (IQR: 2; mean: 1.82). In univariate analysis, DLQI total score was significantly influenced by the clinical course of vitiligo, disease extension over the body, and location on face and/or hands. Multivariate analysis using logistic stepwise regression showed that only the localization on the hands and on the face influenced significantly the mean DLQI.

CONCLUSION

Our study conducted on a random sample of individuals affected by vitiligo selected from the general young male population in Italy, does not document a large impact of vitiligo on QoL. However, variations exist and the location of lesions on the face and/or hands may impact on QoL. Population-based studies are not affected by selection biases connected with seeking medical care and should be more widely performed.

Vitiligo and autoimmunity: an epidemiological study in a representative sample of young Italian males

BACKGROUND

It is stated that patients with vitiligo have an increased risk of developing autoimmune diseases.

OBJECTIVE

The aim of this study was to estimate the prevalence of autoantibodies or overt autoimmune diseases in a group of vitiligo patients examined among a sample deemed to be representative of the general population of young men living in southern Italy.

METHODS

A total of 60 vitiligo patients were identified among 34,740 potential conscripts visited to evaluate their fitness to compulsory service in Italian Navy, obtaining a prevalence of 0.17% (95% CI: 0.13-0.22), which was deemed the prevalence of vitiligo in the Italian general population of the same age and sex. Forty of these vitiligo patients underwent blood test including also the search of the main autoantibodies.

RESULTS

Circulating autoantibodies were detected in 42.5% of subjects. Anti-thyroglobulin antibodies were documented in 27.5%, anti-thyroperoxidase in 22.5%, anti-smooth muscle in 17.3%, anti-nuclear, anti-mitochondrial and anti-gastric parietal cells in 2.5% respectively. Only in two cases (5%) an overt thyroid disease was diagnosed. No significant association between the extension of the skin involved ⁄ clinical course of the disease and circulating autoantibodies was detected. Circulating autoantibodies (particularly anti-thyroid antibodies) were statistically associated with a lower duration of the disease.

CONCLUSIONS

In agreement with other studies, autoantibodies in the lack of clinical manifestations have been frequently observed in our vitiligo patients, especially during the early phase of the disease. The clinical significance of this finding seems to be limited, with the possible exception of thyroid disease, and it needs further exploration, through large cohort studies.

Rituximab for the treatment of patients with chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disorder that originates from antigen-experienced B lymphocytes that do not die and hence accumulate due to external survival signals or undergo apoptosis and are replenished by proliferating precursors. These neoplastic lymphocytes exhibit a characteristic immunophenotype of CD5(+)/CD19(+)/CD20(+)/HLA-DR+/CD23(+)/sIgdim. Thus, the CD20 antigen has been an appealing target for therapy. The introduction of the monoclonal antibody rituximab (anti-CD20) enabled an outstanding advance in CLL treatment. The introduction of this monoclonal antibody into chemotherapy regimens has dramatically improved complete response rates and progression-free survival in patients with both untreated and relapsed CLL. Although only preliminary data from phase III confirmatory trials have been reported, the FCR regimen, which combines fludarabine and cyclophosphamide with rituximab, is currently the most effective treatment regimen for CLL patients, and has also been demonstrated to significantly improve overall survival. The success of rituximab and the identification of other CLL lymphocyte surface antigens have spurred the development of a multitude of monoclonal antibodies targeting distinct proteins and epitopes in an attempt to target CLL cells more effectively.

Kinetics of the lipoperoxyl radical-scavenging activity of indicaxanthin in solution and unilamellar liposomes

The reaction of the phytochemical indicaxanthin with lipoperoxyl radicals generated in methyl linoleate methanol solution by 2,2'-azobis(2,4-dimethylvaleronitrile), and in aqueous soybean phosphatidylcholine unilamellar liposomes by 2,2'-azobis(2-amidinopropane)hydrochloride, was studied. The molecule acts as a chain-terminating lipoperoxyl radical scavenger in solution, with a calculated inhibition constant of 3.63 x 10(5) M(-1) s(-1), and a stoichiometric factor approaching 2. Indicaxanthin incorporated in liposomes prevented lipid oxidation, inducing clear-cut lag periods and decrease of the propagation rate. Both effects were concentration-dependent, but not linearly related to the phytochemical concentration. The consumption of indicaxanthin during liposome oxidation was remarkably delayed, the lower the concentration the longer the time-interval during which it remained in its native state. Indicaxanthin and alpha-tocopherol, simultaneously incorporated in liposomes, exhibited cooperative antioxidant effects and reciprocal protective interactions. The extent of synergism decreased at the increase of the ratio (indicaxanthin)/(alpha-tocopherol). A potential antioxidant mechanism of indicaxanthin is discussed in the context of the chemistry of the molecule, and of the possible reactivity of a short-lived intermediate.

Cytoprotective effects of the antioxidant phytochemical indicaxanthin in β-thalassemia red blood cells

Antioxidant phytochemicals are investigated as novel treatments for supportive therapy in beta-thalassemia. The dietary indicaxanthin was assessed for its protective effects on human beta-thalassemic RBCs submitted in vitro to oxidative haemolysis by cumene hydroperoxide. Indicaxanthin at 1.0-10 microM enhanced the resistance to haemolysis dose-dependently. In addition, it prevented lipid and haemoglobin (Hb) oxidation, and retarded vitamin E and GSH depletion. After ex vivo spiking of blood from thalassemia patients with indicaxanthin, the phytochemical was recovered in the soluble cell compartment of the RBCs. A spectrophotometric study showed that indicaxanthin can reduce perferryl-Hb generated in solution from met-Hb and hydrogen peroxide (H2O2), more effectively than either Trolox or vitamin C. Collectively our results demonstrate that indicaxanthin can be incorporated into the redox machinery of beta-thalassemic RBC and defend the cell from oxidation, possibly interfering with perferryl-Hb, a reactive intermediate in the hydroperoxide-dependent Hb degradation. Opportunities of therapeutic interest for beta-thalassemia may be considered.

Hepatitis A seroprevalence in Tuscany, Italy

Information regarding the current seroprevalence of hepatitis A virus (HAV) is useful for the control of HAV infections. The objective of our study was to evaluate the prevalence of anti-HAV antibodies among children (1-5 years old) and young adults (15-20 years old) in Tuscany, in central Italy. A total of 565 sera were collected in three years 1992, 1998 and 2004, equally distributed between the two age groups. The overal proportion of those that tested positive for anti-HAV antibodies was 8.3%. The proportion of immune children (1-5 years old) statistically significantly increased over the years. The percentage of immune subjects among 15-20-year-old young adults varied over the years, not showing a significant statistical trend, nevertheless our findings indicate that in a low endemicity area, adolescents and young adults are becoming increasingly susceptible to HAV infection. On-going monitoring of immunity to HAV is necessary for detecting trends over time.

Hepatitis A seroprevalence in Tuscany, Italy

Information regarding the current seroprevalence of hepatitis A virus (HAV) is useful for the control of HAV infections. The objective of our study was to evaluate the prevalence of anti-HAV antibodies among children (1-5 years old) and young adults (15-20 years old) in Tuscany, in central Italy. A total of 565 sera were collected in three years 1992, 1998 and 2004, equally distributed between the two age groups. The overal proportion of those that tested positive for anti-HAV antibodies was 8.3%. The proportion of immune children (1-5 years old) statistically significantly increased over the years. The percentage of immune subjects among 15-20-year-old young adults varied over the years, not showing a significant statistical trend, nevertheless our findings indicate that in a low endemicity area, adolescents and young adults are becoming increasingly susceptible to HAV infection. On-going monitoring of immunity to HAV is necessary for detecting trends over time.

Seroprevalence of bactericidal antibody against Neisseria meningitidis serogroup C in pre-vaccinal era: the Italian epidemiological scenario

Meningococcal disease is particularly severe. The case-fatality rate is 7.78% in Europe and 10-14% in the USA. This paper reports the results of a sero-epidemiological study in Italy on meningitis due to Meningococcus C before the introduction of the monovalent conjugate vaccine. In 2003-2004, a total of 577 sera were collected in 17 of the 20 Italian Regions. Serum Bactericidal Assay (SBA) was performed by using rabbit complement serum according to standardized SBA. The results showed that the percentages of protected subjects decreased from 6 to 12 months of age, increased from 1 to 4 years, decreased again until the age of 8 years and from 13 to 16 years, and were particularly high in 9- and 17-year-old subjects. The geometric mean titre of bactericidal antibodies (SBAbs GMT) was low in subjects under 1 year of age, significantly increased in 1-9-year-old children and decreased in adolescents and young adults. Finally, in each one-year age-group, low levels of antibodies were observed in subjects under 1 year of age, in 10-year-old subjects and in 14-16-year-old adolescents. High titres were observed in 3-, 8-, 9- and 17-year-old subjects. Our results therefore indicate that meningococcus C has the highest probability of spreading among 1-4, 8-10 and 14-17-year-old subjects in Italy.

Serological response to hepatitis B virus vaccine in HIV-infected children in Tanzania

BACKGROUND

HIV-infected children have a lower seroconversion rate to hepatitis B virus (HBV) immunization than healthy children. Previous studies have produced conflicting results on CD4 cell counts as predictors of vaccine response. No study has evaluated the response rate to HBV vaccination in HIV-infected children receiving highly active antiretroviral therapy (HAART). Our aim was to vaccinate HIV-infected children living in a close community and to investigate the anamnestic response rate after vaccination with its predictors.

METHODS

Eighty-four HIV-positive children aged 1-10 years who were negative for antibodies to the HBV core antigen (anti-HBc) completed immunization with three doses of 5 microg HBVAXPRO (Aventis, Milan, Italy). Quantitative testing for antibodies to the HBV surface antigen (anti-HBs) was performed: a seroprotective titre was defined as anti-HBs>10 mUI/mL.

RESULTS

After the vaccination, the anti-HBs seroconversion rate was 59.5%. It was higher in individuals in Centers for Disease Control and Prevention (CDC) immune category 1 than in those in CDC categories 2 and 3. Seroconversion was found in 70.8% of HAART-treated and 44.4% of treatment-naïve children. In multivariable models, HAART use and absolute CD4 cell counts were independently associated with probability of seroconversion and with higher anti-HBs titres.

CONCLUSIONS

We found a higher seroconversion rate compared with previous studies in HIV-infected children. In children who are candidates to receive antiretroviral therapy, it may be advisable to defer HBV vaccination until after treatment initiation.

An improved Voronoi-diagram-based neural net for pattern classification

We propose a novel two-layer neural network to answer a point query in R(n) which is partitioned into polyhedral regions; such a task solves among others nearest neighbor clustering. As in previous approaches to the problem, our design is based on the use of Voronoi diagrams. However, our approach results in substantial reduction of the number of neurons, completely eliminating the second layer, at the price of requiring only two additional clock steps. In addition, the design process is also simplified while retaining the main advantage of the approach, namely its ability to furnish precise values for the number of neurons and the connection weights necessitating neither trial and error type iterations nor ad hoc parameters.

Bioactive components of caper (Capparis spinosa L.) from Sicily and antioxidant effects in a red meat simulated gastric digestion

An increasing body of evidence on the association between adherence to the Mediterranean diet and healthy status is being accumulated. Floral buds of Capparis spinosa L. are commonly used in the Mediterranean cuisine as flavoring for meat and other foods. The present study evaluated bioactive components and antioxidant activity of Sicilian capers stabilized in salt. Whereas alpha-tocopherol was absent, low levels of gamma-tocopherol and vitamin C were measured. With reference to one serving size (8.6 g of capers), rutin was 13.76 mg, isothiocyanates, recently acknowledged as anticarcinogen phytochemicals, were 42.14 micromol, total phenols were 4.19 mg of gallic acid equivalents (GAE), and the total antioxidant potential measured using the [2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid)] diammonium salt (ABTS) cation radical decolorization assay was 25.8 micromol of Trolox equivalents. The antioxidative activity of a caper hydrophilic extract was assessed in a number of assays. The extract at 3.5 and 7.0 microM GAE exhibited a dose-dependent peroxyl radical scavenging activity in a methyl linoleate methanol solution oxidized by azo initiator, and reduced hypervalent iron myoglobin species formed from met-Mb an H 2O 2, at 180 microM GAE. The hydrophilic extract, at 70-280 microM GAE, caused a dose-dependent inhibition of lipid autoxidation in heated red meat, incubated with simulated gastric fluid for 180 min. In the same model rutin tested at a concentration corresponding to its content in the extract was ineffective, and alpha-tocopherol at 25 microM was poorly effective. The hydrophilic extract (70 microM GAE) prevented the consumption of the co-incubated alpha-tocopherol, whereas lipid oxidation was inhibited for the experimental time, suggesting cooperative interactions between extract components and the vitamin. The findings encourage the use of caper with foods that contribute oxidizable lipids in view of the association between dietary oxidized lipids and risk of oxidative stress-based diseases.

The ?EpiEnlist? project: a dermo-epidemiologic study on a representative sample of young Italian males. Prevalence of selected pigmentary lesions

BACKGROUND

Few studies on the prevalence and incidence of many skin conditions in the general population are available because it is difficult to submit to dermatologic examination large samples of seemingly healthy population.

OBJECTIVE

The aim of this study was to estimate the prevalence of several skin conditions among a sample that is deemed to be representative of the general population of young men living in southern Italy.

PATIENTS/METHODS

Potential conscripts resident in the coastal regions of southern Italy and called at the age of 18 to the Draft's Council Medical Unit in Taranto underwent a clinical and instrumental examination to evaluate their psycho-physical fitness to compulsory service in Italian Navy. From January 1998 to April 2004 a dermo-epidemiologic project named EpiEnlist (EPIdemiology in ENLISTed Men) project was carried out by the Department of Dermatology of the Italian Navy Hospital in Taranto under the auspices of the Italian Group for Epidemiological Research in Dermatology. All the subjects showing skin lesions evocative of neurofibromatosis (NF), congenital melanocytic nevus (CMN), Becker nevus (BN), and vitiligo were referred to the Department of Dermatology of the Italian Navy Hospital for confirming the diagnosis. The confirmed cases were recorded in a predefined patient's card, containing the main anamnestic, clinical, instrumental, and laboratory data.

RESULTS

Because the recording of the various conditions started and ended in different times, the total number of examined subjects varied. NF type 1 was diagnosed in 6 of 34 740 subjects [prevalence 1:5735 or 0.017%; 95% confidence interval (95% CI), 0.0008-0.0037], CMN in 157 of 23 354 (prevalence 1:148 or 0.67%; 95% CI, 0.57-0.79). BN was observed in 70 of 27 954 young men (prevalence 1:399 or 0.25%; 95% CI, 0.15-0.35), and its mean age of appearance was 11.9 years (minimum 5-maximum 17). In 41 subjects (58.6%), the age of appearance was over 10 years. Vitiligo was recorded in 60 of 34 740 persons (prevalence 1:579 or 0.17%; 95% CI, 0.13-0.22). In 40 subjects with vitiligo, the blood test was done: in 40% of these circulating autoantibodies, mainly anti-thyroid (25.6%) and anti-smooth muscle (17.3%) autoantibodies were detected, but only in 5% of cases, a thyroid disease was diagnosed, and no other sign of autoimmune diseases was observed.

CONCLUSIONS

The epidemiological data of the skin conditions considered in the present study can be considered roughly in agreement with those reported in the available surveys. Because they were obtained in a large sample of Italian young males from the general population, they can be useful for therapeutic and preventive interventions by the public health organizations.

Isolation of a fragment homologous to the rp49 constitutive gene of Drosophila in the Neotropical malaria vector Anopheles aquasalis (Diptera: Culicidae)

The constitutive ribosomal gene rp49 is frequently used as an endogenous control in Drosophila gene expression experiments. Using the degenerate primer PCR technique we have cloned a fragment homologous to this gene in Anopheles aquasalis Curry, a Neotropical vector of malaria. In addition, based on this first sequence, a new primer was designed, which allowed the isolation of fragments of rp49 in two other species, Aedes aegypti (Linnaeus) and Culex quinquefasciatus Say, suggesting that it could be used to clone fragments of this gene in a number of other mosquito species. Primers were also designed to specifically amplify rp49 cDNA fragments in An. aquasalis and Ae. aegypti, showing that rp49 could be used as a good constitutive control in gene expression studies of these and other vectorially important mosquito species.

Antioxidant betalains from cactus pear (Opuntia ficus-indica) inhibit endothelial ICAM-1 expression

It has been suggested that some pigments would have antioxidant properties and that their presence in dietary constituents would contribute to reduce the risk of oxidative stress-correlated diseases. Among others, inflammatory response depends on redox status and may implicate oxidative stress. Vascular endothelial cells are a direct target of oxidative stress in inflammation. We have tested the impact of the free radical scavenger and antioxidant properties of betalains from the prickle pear in an in vitro model of endothelial cells. Here we show the capacity of betalains to protect endothelium from cytokine-induced redox state alteration, through ICAM-1 inhibition.

Melatonin reduces oxidative stress in surgical neonates

BACKGROUND/PURPOSE

Cytokines are inflammatory mediators found in the circulation after surgery. Newborns have less protection against oxidation and are very susceptible to free radical oxidative damage. Melatonin has been reported recently to reduce oxidative stress in neonates with sepsis, asphyxia, and respiratory distress. The aim of this study has been to determine if melatonin would lower interleukin (IL)-6, IL-8, tumor necrosis factor alpha (TNF-alpha) and nitrite/nitrate (NOx) levels and modify serum inflammation parameters, improving the clinical course of surgical neonates.

METHODS

Ten newborns (group 1), 5 with surgical malformations and respiratory distress (group 1a) and 5 with isolated abdominal surgical malformations (group 1b) received a total of 10 doses of melatonin (10 mg/kg) at defined times interval for 72 hours. The treatment was started within 3 hours after the end of surgery. Ten surgical neonates (group 2), did not receive melatonin. Twenty healthy neonates (group 3) served as control. Blood samples were collected at the end of operation; before treatment with the antioxidant; and 24 hours 72 hours, and 7 days after start of treatment with melatonin or placebo, respectively.

RESULTS

Postoperative value of cytokines and NOx levels of groups 1 and 2 were significantly higher than group 3. Compared with group 1b, group 2 displayed significantly higher cytokines and NOx levels at 24 hours, 72 hours, and at 7 days. In group 1a the immediate postoperative values of cytokines were significantly higher than group 1b and group 2, but a significant improvement was observed after administration of melatonin with significantly lower levels of IL-6 and IL-8 with respect to group 2. An improvement of clinical outcome was observed by progressive reduction of clinical parameters of inflammation.

CONCLUSIONS

Melatonin reduces cytokines and NOx levels showing potent antioxidant properties with improvement in clinical outcome. Further studies are warranted to define, on larger numbers, the role of melatonin in surgical patients.

Segmentation for robust tracking in the presence of severe occlusion

Tracking an object in a sequence of images can fail due to partial occlusion or clutter. Robustness to occlusion can be increased by tracking the object as a set of "parts" such that not all of these are occluded at the same time. However, successful implementation of this idea hinges upon finding a suitable set of parts. In this paper we propose a novel segmentation, specifically designed to improve robustness against occlusion in the context of tracking. The main result shows that tracking the parts resulting from this segmentation outperforms both tracking parts obtained through traditional segmentations, and tracking the entire target. Additional results include a statistical analysis of the correlation between features of a part and tracking error, and identifying a cost function that exhibits a high degree of correlation with the tracking error.