A case of Endometriosis of the Trapezius Muscle

A case of endometriosis of the trapezius muscle functionally active, is reported. The etiopathogenetic aspects of extragenital and extraabdominal endometriosis are discussed.

Proposal for a Clinical Classification of Liver Metastases

The lack of a worldwide-accepted classification of liver metastases makes it difficult to compare data on natural history and results from different treatments. The increasing interest in aggressive multimodal therapies for hepatic metastases prompted us to review the chief prognostic factors and the main published classifications in order to propose a new clinical classification, whose principal application concerns metastases from colorectal adenocarcinomas. Following the general rules of the TNM classification, liver metastases are classified by expressing with letters and numbers the parameters selected for their prognostic importance, clinical applicability and objectivity. H (hepatic) is the letter that indicates the liver is the site of metastasis. Synchronous metastases are indicated by H, metachronous by rH (r = recurrent). The extent of liver involvement is defined: H1, liver involvement less than 25%; H2, from 25 to 50%; H3, more than 50%. Site of metastases is defined by s (single), m (multiple to one surgical lobe), b (to both lobes), i (infiltration of important structures). The alteration of liver functions is indicated by F. The presence of cirrhosis is noted by C.

Prolonged Arterial Infusion Chemotherapy in Advanced Head and Neck Tumors

The cases of advanced head and neck tumors treated with palliative chemotherapy by prolonged arterial infusion at the National Cancer Institute of Milan, Italy, between 1960 and 1970 are reviewed. The drugs most frequently used were: Methotrexate (alone or associated with Daunorubycin), Daunorubycin and Adriamycin. 97 infusions were performed in 92 patients and 63 had lesions suitable for evaluation. Regression occurred in 43 (68.3%): over 50% of the starting size of the tumor in 15 and under 50% in 28; 13 patients died as a result of the treatment. Side-effects were numerous and frequent and the incidence of local complications was high, especially in cases of direct cannulation, which also ensured the biggest decreases in tumor size. Cancer of the movable part of the tongue was most responsive to the treatment. Adriamycin with 88 % of regressions and Methotrexate with 73 % were the most effective drugs. The results of this series show that prolonged intra-arterial chemotherapy can yield a high regression rate in head and neck cancer but is is not devoid of serious side-effects and the incidence of local toxic and technical complications is high. Because of this and of the short duration of regression, it is doubtful whether arterial infusion represents an advance over other modes of administering chemotherapy.

Adenolymphoma of the Parotid Gland

In the period 1928–1968 in a series of 355 benign and malignant tumors of the parotid observed at the National Cancer Institute in Milan there were 36 cases of adenolymphoma. The clinical, morbid anatomy and histogenetic features of these cases are described. On the strength of the following findings: normal salivary tissue enclosed within an intraparotid lymph node, the association of a mixed tumor and an adenolymphoma in the same gland, the bilaterality of the tumor in 2 cases and the functional activity demonstrated with 131I, the salivary origin of adenolymphoma is argued. As to treatment, given the biological characteristics of the tumor, enucleation/resection would seem to be the operation of choice. For various reasons, however, including the difficulty of a precise preoperative diagnosis, total parotidectomy, sparing the 7th cranial nerves, is more often performed.

Identification of a newly described OsHV-1 µvar from the North Adriatic Sea (Italy)

The surveillance activities for abnormal bivalve mortality events in Italy include the diagnosis of ostreid herpesvirus type 1 (OsHV-1) in symptomatic oysters. OsHV-1-positive oysters (Crassostrea gigas) were used as a source for in vivo virus propagation and a virus-rich sample was selected to perform shotgun sequencing based on Illumina technology. Starting from this unpurified supernatant sample from gills and mantle, we generated 3.5 million reads (2×300 bp) and de novo assembled the whole genome of an Italian OsHV-1 microvariant (OsHV-1-PT). The OsHV-1-PT genome encodes 125 putative ORFs, 7 of which had not previously been predicted in other sequenced Malacoherpesviridae. Overall, OsHV-1-PT displays typical microvariant OsHV-1 genome features, while few polymorphisms (0.08 %) determine its uniqueness. As little is known about the genetic determinants of OsHV-1 virulence, comparing complete OsHV-1 genomes supports a better understanding of the virus pathogenicity and provides new insights into virus-host interactions.

MicroRNAs in bone diseases

MicroRNAs are small, noncoding single-stranded RNAs that have emerged as important posttranscriptional regulators of gene expression, with an essential role in vertebrate development and different biological processes. This review highlights the recent advances in the function of miRNAs and their roles in bone remodeling and bone diseases. MicroRNAs (miRNAs) are a class of small (∼22 nt), noncoding single-stranded RNAs that have emerged as important posttranscriptional regulators of gene expression. They are essential for vertebrate development and play critical roles in different biological processes related to cell differentiation, activity, metabolism, and apoptosis. A rising number of experimental reports now indicate that miRNAs contribute to every step of osteogenesis and bone homeostasis, from embryonic skeletal development to maintenance of adult bone tissue, by regulating the growth, differentiation, and activity of different cell systems inside and outside the skeleton. Importantly, emerging information from animal studies suggests that targeting miRNAs might become an attractive and new therapeutic approach for osteoporosis or other skeletal diseases, even though there are still major concerns related to potential off target effects and the need of efficient delivery methods in vivo. Moreover, besides their recognized effects at the cellular level, evidence is also gathering that miRNAs are excreted and can circulate in the blood or other body fluids with potential paracrine or endocrine functions. Thus, they could represent suitable candidates for becoming sensitive disease biomarkers in different pathologic conditions, including skeletal disorders. Despite these promising perspectives more work remains to be done until miRNAs can serve as robust therapeutic targets or established diagnostic tools for precision medicine in skeletal disorders.

Enhancement of flavonoid ability to cross the blood-brain barrier of rats by co-administration with α-tocopherol

Vitamin E and polyphenols could exhibit a therapeutic role in the treatment of oxidative stress-induced neurodegenerative diseases. Therefore, their ability to cross the blood-brain barrier (BBB) represents an important issue to be explored by different diet combinations. In this study, we have evaluated the ability of α-tocopherol to support epigallocatechin-3-gallate (EGCG), quercetin and rutin to cross the BBB, following oral administration. Eighteen rats were fed a standard diet (C), a diet supplemented with α-tocopherol (A), with a mixture of EGCG, quercetin and rutin (P); or with a mixture of α-tocopherol and the three flavonoids (AP). Flavonoids and their conjugated derivatives were assayed in brain and plasma by HPLC-MS, whereas α-tocopherol was detected by RP-HPLC. The oxidative damage, due to the potential pro-oxidant activity of flavonoids, was evaluated by the presence of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in hippocampal Cornus Ammonis, one of the most vulnerable sites in the brain. Our results indicate that α-tocopherol is able to promote quercetin transport across the BBB. The mixture of rutin and quercetin seems to favour the accumulation of quercetin and/or its conjugated derivatives in the brain. In contrast, α-tocopherol does not affect EGCG transport across the BBB. The densitometric analysis of 8-OHdG immunoreactivity does not reveal any difference of oxidative damage among the experimental groups. Our results suggest that α-tocopherol may promote quercetin transport across the BBB, leading to a significant increase of α-tocopherol and quercetin concentration in the brain.

An enzyme-linked immunosorbent assay for the measurement of plasma flavonoids in mice fed apigenin-C-glycoside

BACKGROUND

In the Chenopodiaceae family, the apigenin flavonoids vitexin-2-O-xyloside (VOX) and vitexin-2-O-rhamnoside (VOR) are important chemopreventive components. To investigate their bioavailability in in vivo animal studies an enzyme-linked immunosorbent assay (ELISA) method has been developed.

RESULTS

The ELISA was based on polyclonal antibodies elicited in mice by injecting, as an immunogen, 4',6″-O-biapigenin (hinokiflavone, HF) conjugated to bovine serum albumin (BSA-HF). A second immunogen was synthesised by coupling an equimolar mixture of VOX and VOR to BSA (BSA-F1). The BSA-HF elicited a significant antibody response, due to 17 HF hapten groups, coupled to each BSA molecule, whereas BSA-F1 provided a very low antigenicity in respect to control animals. Antiserum raised against BSA-HF showed an antibody titre of 1:1600. Antibodies were found to be specific for the flavonols. Our results show that VOX and its metabolic products reached the concentration of 3.42 ± 0.72 µg mL⁻¹ in plasma of VOX fed animals, at the net of the control value.

CONCLUSIONS

By using the ELISA, the concentration of apigenin flavonoids and their metabolites can be detected in VOX- or VOR-supplemented animals. The assay represents a useful tool for rapid screening to compare bioavailability of apigenin flavonoids in respect to control animals.

Vitexin-2-O-xyloside, raphasatin and (-)-epigallocatechin-3-gallate synergistically affect cell growth and apoptosis of colon cancer cells

Cytotoxic effects of the combination of the food components vitexin-2-O-xyloside (X), raphasatin (4-methylsulphanyl-3-butenyl isothiocyanates; G) and (-)-epigallocatechin-3-gallate (E) were investigated in colon (LoVo and CaCo-2) and breast (MDA-MB-231 and MCF-7) cancer cells. Breast cancer cells were more resistant than colon cells to X, G and E inhibition. On the contrary, marked synergistic effects among X, G and E on cell growth were found in both colon cancer cells. Further analysis revealed a G0/G1 arrest of the phase cell progression and apoptosis, linked to modulation of Bax, Bcl2, caspase-9 and poly(ADP-ribose) polymerase as well as Reactive Oxygen Species (ROS) generation in both colon cancer cells, whereas apoptosis and ROS were not significantly detected in normal human lymphocytes. We conclude that the X, G and E mixture might act by mitochondrial pathway activation of apoptosis, possibly elicited by ROS and the mixture may be effective in the chemoprevention of colon cancer.

The association of body composition and sex hormones with quantitative ultrasound parameters at the calcaneus and phalanxes in elderly women

We investigated the associations of body composition and sex hormones with quantitative ultrasound (QUS) parameters carried out at different skeletal sites. In 897 postmenopausal women (64.1 ± 6.6 years) we measured QUS at the calcaneus (stiffness) by Achilles-GE and at phalanxes (amplitude-dependent speed of sound [AD-SOS], bone transmission time [BTT], and ultrasound bone profile index [UBPI]) by Bone Profiler-IGEA. In all subjects we measured fat mass (FM), lean mass (LM), android fat, and gynoid fat by DXA. In all subjects we also assessed serum testosterone (T), estradiol (E(2)), sex-hormone binding globulin, free estrogen index (FEI), free androgen index, 25-hydroxyvitamin D (25OHD), bone alkaline phosphatase (B-ALP), and type I collagen β carboxy telopeptide. Both E(2) and FEI showed weak but significant correlations with stiffness and QUS parameters at phalanxes. No significant relationships were found between T and QUS. BMI and LM were positively correlated with stiffness (r = 0.14 and r = 0.17, respectively), whereas BMI and FM showed negative correlations with AD-SOS, BTT, and UBPI. 25OHD showed positive relationships with stiffness and QUS at phalanxes. In multivariate models LM and age were associated with stiffness whereas E(2) and age were significant predictors of BTT. AD-SOS was negatively associated with FM, B-ALP, and age but positively with E(2) and 25OHD. In postmenopausal women QUS parameters at the calcaneus and at phalanxes are significantly, but diversely, associated with body composition, sex hormones, 25OHD, and bone turnover markers.

Vitamin D deficiency and primary hyperparathyroidism

Vitamin D via its receptor has essential actions on parathyroid cells, inhibiting PTH secretion, and parathyroid cell proliferation. While the effects of vitamin D depletion in the pathogenesis of secondary hyperparathyroidism in elderly individuals or in the occurrence of parathyroid hyperplasia in patients with renal insufficiency are well established, the association between hypovitaminosis D and primary hyperparathyroidism (P-HPT) has only recently become appreciated. In different cohorts of patients with P-HPT, vitamin D deficiency has been recently associated with higher PTH levels, larger adenomas, and a more severe phenotype (including osteitis fibrosa cystica) as well as negative post-operative outcomes following parathyroidectomy. Despite current guidelines recommend measurement of serum 25OHD (25-hydroxy-cholecalciferol) in P-HPT and their repletion if the levels are <20 ng/ml, future well-designed trials of vitamin D supplementation in P-HPT patients with coexisting vitamin D deficiency are needed to evaluate the risk/benefit profile of this treatment.

Total extract of Beta vulgaris var. cicla seeds versus its purified phenolic components: antioxidant activities and antiproliferative effects against colon cancer cells

INTRODUCTION

Beta vulgaris var. cicla (BV) leaves contain chemopreventive compounds that have been investigated for new drug discovery. These compounds belong to the family of the apigenin-glycosides. Since the leaves are seasonal products containing high percentages of water, they are easily degradable during storage in fresh conditions. To be stored they require a drying process, consuming time and a large amount of energy. The extraction of apigenin-glycosides may also be conveniently performed from BV seeds, which represent a stable and year-long available biomass.

OBJECTIVES

The present report was undertaken to find a strategy of purification of bioactive flavonoids from BV seeds and test their ability to inhibit proliferation both on human colon cancer (RKO) cells and normal human fibroblasts (HF).

MATERIALS AND METHODS

The ethyl-acetate extract of BV seeds was fractionated on a Sephadex LH 20 column. A fraction of this extract, labeled as P4, exploited a marked antiproliferative activity on RKO cells. The components of P4 were purified on an RP₁₈ column chromatography and identified by HPLC-ESI-MS as 2,4,5-trihydroxybenzaldehyde, 2,5-dihydroxybenzaldehyde, vanillic acid, xylosylvitexin, glucopyranosyl-glucopyrasyl-rhamnetin and glucopyranosyl-xylosyl-rhamnetin. All of them were tested for cytostatic and cytotoxic activity on RKO and HF cells.

RESULTS

Xylosylvitexin exhibited the strongest antiproliferative activity on RKO cells, together with an enhancement of the apoptosis, an increase of cells in the G₁ phase and a reduction of cells in the S phase; on the contrary, the proliferation of HF was significantly stimulated.

CONCLUSION

Xylosylvitexin is the main and more efficient chemopreventive compound in BV seeds, but the natural cocktail of molecules, represented by P4 fraction, showed a better compromise between the antiproliferative activity on RKO cells and the enhancement of HF proliferation.

Chemical and cellular antioxidant activity of phytochemicals purified from olive mill waste waters

The isolation and identification of a phytocomplex from olive mill waste waters (OMWW) was achieved. The isolated phytocomplex is made up of the following three phenolic compounds: hydroxytyrosol (3,4-DHPEA), tyrosol (p-HPEA) and the dialdehydic form of decarboxymethyl elenolic acid, linked with (3,4-dihydroxyphenyl)ethanol (3,4-DHPEA-EDA). The purification of this phytocomplex was reached by partial dehydration of the OMWW, followed by liquid-liquid extraction with ethyl acetate and middle pressure liquid chromatography (MPLC) on a Sephadex LH-20 column. The phytocomplex accounted for 6% of the total phenolic content of the OMWW. The phytocomplex and individual compounds were tested for antioxidant capacity by the oxygen radical absorbance capacity (ORAC) method. The ORAC phytocomplex produced 10,000 ORAC units/g dry weight, whereas the cellular antioxidant activity, measured by the cellular antioxidant activity in red blood cell (CAA-RBC) method, demonstrated that the phytocomplex and all of the components are able to permeate the cell membrane thus exhibiting antioxidant activity inside the red blood cells. Our phytocomplex could be employed in the formulation of fortified foods and nutraceuticals, with the goal to obtain substantial health protective effects due to the suitable combination of the component molecules.

The role of PET-CT in the follow-up of patients with urothelial cancer diagnosis

291

Background: Positron emission tomography (PET) is an imaging technique whose principle is the detection of metabolic activity of tumor cells but in urology its use had been restricted due to urinary excretion of the radiotracer and overlap with urological structures, the use of hybrid PET (PET-CT) would allow its use for monitoring patients with urothelial tumors.

Methods: Between 2007 and 2010 we performed PET-TC images in consecutive patients with suspected recurrences in CT scan or MRI. All patients had renal, bladder and uretral cancer and were treated with urothelial cancer diagnosis. We evaluate the usefulness of FDG PET-CT and its impact on behavior therapy in suspected recurrence in patients with urothelial carcinoma, compared with conventional studies.

Results: 17 patients were studied for suspected recurrence. All patients had positive images previously on CT scan and MRI; positive PET-TC was observed in 14 and 3 studies were negative. The positive PET-CT showed more number of lesions and change the medical and surgical strategy. Of the three studies negative on PET- CT none had recurrence and remain disease free. PET/CT is in a great benefit to the detection recurrence in the follow up of patients with urothelial cancer diagnosis. These results showed an increased sensitivity and specificity over previous work with conventional PET technology. In the series studied, the implementation of PET-CT (FDG) in the follow up of patients with urothelial tumors were an useful tool.

Conclusions: PET/CT is in a great benefit to the detection recurrence in the follow up of patients with urothelial cancer diagnosis. These results showed an increased sensitivity and specificity over previous work with conventional PET technology. In the series studied, the implementation of PET-CT (FDG) in the follow up of patients with urothelial tumors were an useful tool. However, multicenter studies and more patients are required to define its role.

No significant financial relationships to disclose.

Sentinel lymph node biopsy in gastric cancer: possible applications and limits

AIMS

To explore the feasibility and accuracy of sentinel lymph node (SLN) biopsy in gastric cancer.

PATIENTS AND METHODS

Twenty-nine patients with clinical T1 and T2 N0 M0 gastric cancer less than 5 cm in diameter underwent SLN biopsy with the intraoperative Patent blue method. The procedure continued with radical gastrectomy and D2 lymphadenectomy. We investigated all technical aspects of the blue dye technique and determined the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the SLN technique.

RESULTS

SLNs were detected in 28 of 29 patients; the total number of excised SLNs was 45, with a median of two (range 1-3). Seventeen patients had metastatic SLN, with 21 lymph nodes retrieved. Twenty-two patients had SLNs located at the first level. Four patients had SLNs at the second level, one at the first and second levels, and one at the first and third levels. Five patients had false negative SLNs. The ability of SLN biopsy to predict the status of the other lymph nodes was summarised by an accuracy of 75%, a sensitivity of 75%, a specificity of 75%, a positive predictive value of 88%, and a negative predictive value of 55%.

CONCLUSIONS

Our study demonstrates that pick-up SLN biopsy in gastric cancer is technically feasible but has very low sensitivity. Regarding the utility of SLN navigation when attempting to detect the nodal basin, the high rate of false negative SLNs and lymph node level jumping warrant further studies with a large accrual before the method can be introduced into daily practice.

Mechanisms of impaired bone strength in type 1 and 2 diabetes

Diabetes and osteoporosis are common and complex disorders with an enormous health burden that can be often associated especially in middle-age and elderly individuals. Although there is raising awareness of the higher fractures rates among patients with type 1 (DM1) and 2 (DM2) diabetes, there are few data available on the pathogenetic mechanisms responsible for this increased risk. Importantly, several experimental and clinical observations suggest that bone abnormalities associated with diabetes may differ, at least in part, from those associated with senile or post-menopausal osteoporosis. This implies that specific preventive and therapeutic strategies have to be developed and tested to prevent fractures in DM1 and DM2 patients. It is also likely that shared (i.e. due to glucose-toxicity) as well as different (i.e. due to insulin levels or other hormones) mechanisms may be associated with bone fragility in DM1 and DM2. Moreover, the hypothesis of an endocrine role of the skeleton in the regulation of glucose metabolism and insulin sensitivity has been recently proposed by experimental observations. This review summarizes the recent clinical and experimental advances on glucose tolerance, bone fragility and osteoporosis associated with diabetes.

Epidemiological, clinical, and genetic characteristics of Paget's disease of bone in a rural area of Calabria, Southern Italy

BACKGROUND

The prevalence of Paget's disease of bone (PDB) is unknown in peninsular Southern Italy, although an elevated clinical severity of the disease was reported in patients from Campania.

AIM

This study was performed to evaluate the epidemiological and genetic characteristics of PDB in a rural area of Calabria, the southernmost region in the Italian peninsula.

SUBJECTS AND METHODS

We examined 1068 consecutive pelvic radiographs of patients older than 40 yr referred for any reason to the "Spinelli" Hospital, Belvedere Marittimo, from January 1st 2004 to December 31st 2006. In subjects with radiological findings of pelvic PDB, a 99m Technetium methylene diphosphonate bone scan and the sequence analysis of the sequestosome 1 (SQSTM1) gene were subsequently performed.

RESULTS

In the examined geographic area, the crude radiographic prevalence of pelvic PDB was 0.74% (8/1068; male:female 5:3, mean age 71.6 ± 13.1 yr) whereas the estimated overall prevalence of PDB between 0.82% and 1.21%. PDB patients from Calabria showed clinical characteristics similar to those reported in patients from Campania. The disease was also frequently complicated by osteoarthritis and the right side of the body was more affected than the left. The SQSTM1 gene analysis revealed the presence of a novel missense mutation (M401V) in exon 8 in one subject with a familial and aggressive form of PDB.

CONCLUSION

The study results confirmed that patients with PDB from rural districts of Southern Italy show an earlier onset and an increased clinical severity of the disease that appears mostly independent from the presence of germinal SQSTM1 mutations.

Bone fragility in men: where are we?

Osteoporosis in men is an increasingly important clinical issue. About one in three osteoporotic fractures occur in men, and the consequences of these fractures are generally more severe than in women. Despite these evidences, osteoporosis remains under-recognized and undertreated in men. This review provides a summary of recent developments about the causes, pathogenesis, and treatment of osteoporosis in men.

Perspectives in the treatment and prevention of osteoporosis

Osteoporosis is a chronic skeletal condition characterized by compromised bone strength. This disorder affects a substantial proportion of the elderly population and causes notable morbidity, deterioration in quality of life and mortality due to associated fragility fractures. Over the past two decades the range of therapeutic options for the treatment of osteoporosis and fracture prevention has increased dramatically with the development of potent antiresorptive and anabolic agents. This review summarizes the effects of existing treatment options and of promising new therapies for osteoporosis prevention and treatment.

Preliminary report of the mutation status of KRAS and BRAF-V600E in an Argentinean population of primary colorectal tumors

e22183

Background: Several studies have suggested that KRAS somatic mutations predict resistance to Cetuximab treatment in colorectal cancers. The aim of this report is to present the mutational status of KRAS, BRAF and epidemiological data of an Argentinean population of CR tumors which may have future clinical practice implications. Methods: Patients were prospectively selected from the databases of 8 Argentinean public and private hospitals with colorectal cancer between January and December 2008. We analyzed the presence of KRAS point mutations in codons 12 and 13, and the BRAF-V600E from formalin fixed sections with Polymerase Chain Reaction (PCR) amplification-sequencing. Results: A total of 146 patients, 41.8% (61) F and 57.2% (85) M, with a median age of 58.1 years (range, 17–88), 45.2% (66) were current smokers, 50% (73) never smoke. 41.4% (60) have family history of cancer and 9.6% (14) have personal history of a previous tumor. 63.2% were European Caucasian, 30.3% American Caucasian and 0.7% of Asian origin. The media BMI was 25.9 (range, 16- 47). The primary tumor site was 21.9% (32) right colon, 5.5% (8) transverse colon, 45.2% (66) left colon and 27.4%(40) rectal cancer. Adenocarcinoma was the unique histotype and mucinous differentiation was observed in 14.7% (21). The Pathological Stage at diagnosis was Stage I 3.42% (5), II 24% (35), III 33.6% (49) and IV 39% (57). 60.3% (88) where found to be wild type, while the other 39.7% (58) showed the KRAS mutation in the following amino acids: GLY12ALA 5.2% (3), GLY12ASP 25.9% (15), GLY12CYS 3.4% (2), GLY12SER 1.7% (1), GLY12VAL 62.1 % (36), GLY13ARG 1.7% (1). We analyzed in 49 patients the mutational status of BRAF-V600E, only 2 patients showed the presence of both mutations, 23 presented BRAF and KRAS wild type, 20 had a KRAS mutation while the BRAF was wild type, only 4 patients reveled a mutation of BRAF in the presence of a KRAS wild type. Conclusions: This is the first Argentinean collaborative study of the mutational status of KRAS and BRAF. Our preliminary report based in 146 patients, revealed similar mutational KRAS results in codon 12 and 13 than the reports of Europe. This is probably due to the ethnic origin of Argentinean population.

No significant financial relationships to disclose.