Octreotide and pasireotide effects on medullary thyroid carcinoma (MTC) cells growth, migration and invasion

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine neoplasm of the parafollicular thyroid C cells. Although somatostatin receptors are expressed by MTCs, treatment with octreotide has shown poor efficacy, whereas recently pasireotide has demonstrated antiproliferative effects in persistent postoperative MTCs. Aim of this study was to test the effects of octreotide and pasireotide on MTC cells proliferation, cell cycle proteins expression, MAPK activation, apoptosis, calcitonin secretion, migration and invasion in TT cell line as well as in primary MTC cultured cells. Our results showed that both octreotide and pasireotide reduced TT cell proliferation (-35.2 ± 12.1%, p < 0.001, and -25.3 ± 24.8%, p < 0.05, at 10^-8 M, respectively), with concomitant inhibition of ERK phosphorylation and cyclin D1 expression. This cytostatic effect was accompanied by a proapoptotic action, with an increase of caspase3/7 activity of 1.5-fold. Moreover, both octreotide and pasireotide inhibited cell migration (-50.9 ± 11.3%, p < 0.01, and -40.5 ± 17%, p < 0.05, respectively) and invasion (-61.3 ± 35.1%, p < 0.05, and -49.7 ± 18%, p < 0.01, respectively). No effect was observed on calcitonin secretion. We then tried to extend these observations to primary cultures (n = 5). Octreotide and/or pasireotide were effective in reducing cells proliferation in 3 out of 5 tumors, and to induce cell apoptosis in 1 out of 3 MTCs. Both octreotide and pasireotide were able to reduce cell migration in all MTC tested. SST2, SST3 and SST5 were expressed in all MTC, with a tendency to increased expression of SST2 in RET mutated vs wild type MTCs. In agreement, inhibition of mutated RET in TT cells reduced SST2 expression. In conclusion, we demonstrated that octreotide and pasireotide inhibited cell proliferation and invasiveness in a subset of MTC, supporting their potential use in the control of tumor growth.

Social media and e-learning use among European exercise science students

With the rise of digital technologies, electronic learning and communication tools are becoming a firm part of academia to promote knowledge of health sciences. This study sought to analyse the attitude of students regarding social media and digital learning for study purposes in sport and exercise science. A survey was carried out with a questionnaire (20 main items) in six sport science faculties, equally spread across Germany (G), Italy (I) and the United Kingdom (UK) between February and October 2017. The focus areas were students' usage of social media (Facebook, Google+, Instagram, LinkedIn, Skype, Twitter, WhatsApp, YouTube) for academic purposes and their use of e-learning. Data were analysed by quantitative and qualitative methods. 229 students participated in the study (G: 68, I: 121, UK: 40). While YouTube was mostly used for receiving knowledge, WhatsApp and Facebook showed additional preferences for peer contacts for learning purposes and knowledge discussions. Preferred online data sources were PubMed (77%), free access journals (67%), YouTube (66%) and Wikipedia (63%). Often used digital learning materials were own universities' PowerPoints (77%), scripts (59%) and scientific articles (53%). However, some preferences showed national differences. The evaluated participants showed an overall high use of social media and e-learning tools for their studies. Students would like more digital learning sources made available to them by their institutions. However, some differences in preferences of digital learning or communication tools may exist and this should be considered for international approaches to promote health knowledge among students.

Diode laser as an adjunct to nonsurgical chronic periodontitis therapy: a review

The aim of this review was to investigate the additional effects of diode laser irradiation in combination with nonsurgical periodontal therapy. An electronic search of publications was established from three electronic databases: Cochrane, PubMed and Web of Science. The search strategy used a combination of controlled vocabulary and free-text words. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were all studies published in English language, randomized controlled trials, based on human subjects. All trials were designed to evaluate the efficacy of the diode laser therapy as an adjunct to nonsurgical periodontal therapy in the treatment of chronic periodontitis patients. All studies analyzed are not older than five years. The search resulted in 188 titles. After the analysis of the abstracts, an article was excluded because it was not relevant for the study and two because it treated aggressive periodontitis. At the end only 6 articles were included in the qualitative analysis. The potential role in chronic periodontal disease treatment of diode laser is still not demonstrated. Several studies regard the diode laser therapy, but there is still heterogeneity for what it concerns research and clinical protocols. As a result, several randomized controlled trials are needed to obtain certain data.

Comparison of the accuracy of intraoral scanning and conventional impression techniques on implants: a review

The aim of this review was to collect available evidence and evaluate accuracy outcomes of dental implant impression techniques, and to compare the accuracy of conventional implant impression versus digital implant impression. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were: all studies published in English language; studies no older than five years; analyzing the accuracy of digital vs conventional technique impression on implants. The exclusion criteria were: publications that reported the same data as later publications by the same authors and systematic reviews; commentaries and letters to the editor; case report and case series. The search resulted in 106 titles. Following the first stage of screening, after the records identification through database manual searching, 112 potentially relevant studies were identified. After the second stage screening, 33 full text publications were obtained and analyzed and 17 were excluded. Afterwards, 18 articles resulted eligible after full text reading and a cross search of the articles' references was accomplished; 3 articles were consequently added. At the end only 7 articles were included in the quantitative analysis. Within the limitations of this systematic review, digital impression on dental implants offers a comparable accuracy compared with conventional impressions technique. More clinical trials are recommended to investigate the accuracy of these scanners and their validity in clinical use.

Radiosurgery in dentistry: a review

The aim of the present study was to analyse the clinical potential of radiosurgery applied to modern dentistry through a revision of the indexed literature. Radiosurgery represents a recent form of electrosurgery working at a frequency of 3.0-4.0 MHz. The depth of penetration of the waves is inversely proportional to the frequency. Radiowaves working at high frequency express a lower penetration with a consequent lower tissue alteration. The authors analyzed the literature in order to give to the scientific community an overview of the possible applications of radiosurgery in the clinical dental practice and their effectiveness. Radiosurgery can be used in prosthodontics, in periodontal and implant surgery, in the treatment of trigeminal neuralgia, in the treatment of obstructive sleep apnea syndromes (OSAS) and in endodontics. Our analysis shows that although there are few articles in indixed literature on the applications of radiosurgery in dentistry, thanks to the benefits that derive from it, radiosurgery will spread more in the daily clinical practice of the dentists.

Oral health and implant therapy in Parkinson's patients: review

Parkinson's Disease (PD) is one of the most frequent neurodegenerative diseases, second only to Alzheimer's disease. It is a progressive disease that inevitably leads the patient to death, in most cases for pneumonia ab ingestis. It affects 120 people out of 100,000 and more frequently affects men than women. The main symptoms are divided into motor, non-motor and behavioral ones. The main motors symptoms are tremor, bradykinesia and postural instability. Non-motor symptoms include autonomic nervous dysfunction (orthostatic hypotension, cardiac arrhythmia, sexual dysfunction, excessive sweating due to hypothalamic dysfunction, constipation), insomnia, OSAS, and olfactory dysfunction. Behavioral symptoms are depression, dementia and psychosis. The purpose of this study is to evaluate, through a systematic review of literature, the oral health status of the Parkinson's patient compared with the general population with particular reference to the incidence of caries and periodontal disease, the patient's management during dental interventions and the possibility of rehabilitating the patient with implanted therapy.

Vulvovaginal gingival lichen planus: report of two cases and review of literature

PURPOSE

Oral Lichen Planus (OLP) is a chronic inflammatory disease of skin and mucous membranes. Approximately 20% of women with oral lichen planus develops lesions in the genital mucosa. In 1982, Pelisse described a special form of lichen planus (LP), which consists of a triad of symptoms: vulval, vaginal and gingival (VVG)-LP lesions. Aim of the present report is to report two new cases and review the international literature.

MATERIAL AND METHODS

Two cases of VVG-LP are reported and a review of recent literature is performed.

RESULTS

The onset of erosive or ulcerative mouth lesions may precede or follow by months or even years the onset of vulvovaginal lesions. Vaginal agglutination is associated with the postmenopausal state in conjunction with a dermatologic condition. Intra-lesional corticosteroids have a role in localized chronic ulceration, while systemic therapies such as corticosteroids, azathioprine, mycophenolate mofetil, hydroxychloroquine, ciclosporin, methotrexate, retinoids, thalidomide and photo chemotherapy have been used in more severe cases with varying success.

CONCLUSIONS

VVG-LP is rather a rare condition and has been documented in the literature mainly in the form of case reports. Lack of a precise diagnostic criteria of VVG-LP depends on the specialists.

Screening for ACTH-dependent hypercortisolism in patients affected with pituitary incidentaloma

CONTEXT

Pituitary incidentalomas (PIs) are commonly encountered in clinical practice. The management of these asymptomatic pituitary lesions is still controversial. Systematic screening for subclinical or mild ACTH-dependent hypercortisolism (AH) is not presently recommended, due to the limited data available thus far on the epidemiological and clinical relevance of this condition in patients with PIs. As subclinical hypercortisolism (SH) was considered to be associated with chronic complications of overt cortisol excess, such as hypertension, diabetes, and osteoporosis, this disorder should be diagnosed at the early stage.

OBJECTIVE

The objective of this study was to evaluate the prevalence of hypercortisolism in a population of subjects with PIs.

DESIGN, SUBJECTS, AND METHODS

A total of 68 consecutive patients (48 females and 20 males, aged 18-82 years) without clinically overt hypercortisolism, who were referred for evaluation of PIs between January 2010 and March 2013, were prospectively investigated for AH. Pituitary hypercortisolism was diagnosed in the presence of cortisol >50 nmol/l after 1 mg dexamethasone suppression test, non-suppressed ACTH, and the additional finding of one of the following: urinary free cortisol (UFC) >193 nmol/24 h, and midnight serum and salivary cortisol levels >207 and 2.8 nmol/l respectively.

RESULTS

Among patients with PIs, we found a 7.3% rate of pituitary hypercortisolism diagnosed with biochemical criteria and a 4.4% rate of histologically confirmed AH.

CONCLUSIONS

Subclinical or mild hypercortisolism may be more common than generally perceived in patients with PIs.

Multicenter analytical evaluation of a high-sensitivity troponin T assay

BACKGROUND

High-sensitivity cardiac troponin assays are being introduced clinically for earlier diagnosis of acute myocardial infarction (AMI). We evaluated the analytical performance of a high-sensitivity cardiac troponin T assay (hscTnT, Roche Diagnostics) in a multicenter, international trial.

METHODS

Three US and 5 European sites evaluated hscTnT on the Modular® Analytics E170, cobas® 6000, Elecsys 2010, and cobas® e 411. Precision, accuracy, reportable range, an inter-laboratory comparison trial, and the 99th percentile of a reference population were assessed.

RESULTS

Total imprecision (CVs) were 4.6-36.8% between 3.4 and 10.3 ng/L hscTnT. Assay linearity was up to 10,000 ng/L and the limit of blank and detection were 3 and 5 ng/L, respectively. The 99th percentile reference limit was 14.2 ng/L (n=533). No significant differences between specimen types, assay incubation time, or reagent lots existed. A substantial positive bias (76%) exists between the 4th generation and hscTnT assays at the low end of the measuring range (<50 ng/L). hscTnT serum pool concentrations were within 2SD limits of the mean of means in the comparison trial, indicating comparable results across multiple platforms and laboratories.

CONCLUSION

The Roche hscTnT assay conforms to guideline precision requirements and will likely identify additional patients with myocardial injury suspicious for AMI.

Peripheral insulin-like factor 3 concentrations are reduced in men with type 2 diabetes mellitus: effect of glycemic control and visceral adiposity on Leydig cell function

BACKGROUND AND AIM

Hypogonadism frequently occurs in men with type 2 diabetes mellitus (T2DM), while the role of glycemic control and visceral obesity is still unclear. This study aimed to assess the Leydig cell function, including the new sensitive marker insulin-like factor 3 (INSL3), in T2DM patients without overt hypogonadism and the influence of either glycemic control or visceral adiposity.

SUBJECTS AND METHODS

Thirty T2DM patients (age 57.1+/-6.2 years, body mass index (BMI) 28.0+/-4.3) without overt hypogonadism and 30 age- and BMI-matched controls were studied. Anthropometric, glycometabolic parameters and testosterone, SHBG, LH, INSL3 levels, bioavailable and free testosterone (BT and cFT) were evaluated. The human chorionic gonadotrophin (hCG) test was also performed.

RESULTS

Patients had lower total testosterone (452.6+/-130.0 vs 512.6+/-117.3 ng/dl, P=0.06), BT (189.7+/-36.4 vs 237.1+/-94.1 ng/dl, P=0.002), cFT (8.1+/-1.6 vs 10.1+/-4.0 ng/dl, P=0.002), and higher LH levels (3.5+/-1.6 vs 2.6+/-1.2 mU/ml, P=0.01) versus controls. Serum INSL3 concentrations were also lower in patients (1.1+/-0.3 vs 1.5+/-0.7 ng/ml, P=0.01). These hormonal parameters, including INSL3, did not differ between T2DM patients with poor or good glycemic control (HbA1c>9 or <7% respectively). In patients, waist circumferences (97.9+/-12.4 cm) negatively correlated with INSL3 (P=0.03) and basal, as well as hCG-stimulated testosterone levels (P=0.04 and 0.004 respectively). Basal or stimulated hormonal levels and INSL3 concentrations were not different between patients with (40%) or without erectile dysfunction.

CONCLUSIONS

An early impairment of the overall Leydig cell function is present in men with T2DM, mainly related to visceral adiposity rather than to glycemic control.

The sutures in dentistry

In oral surgery, the last phase of a surgical operation is represented by the tissues suture, that allows the wound lips edges approximation and their stabilization, to promote haemostasis, to avoid the alimentary residues accumulation on the incision line and allow the first intention healing. A good suture avoids that the displacing forces generated by the muscular insertions, functional movements and by the external agents destabilize or cause the surgical wound deiscence. The purpose of this study was to re-examine the suture threads characteristics, properties and biological interactions evaluating the different studies published in literature results and conclusions. In conclusion, the authors recommended the use of the different suture threads on the dependence of the oral surgery operation type that must be performed, of the patient compliance and of the various suture materials physical and biocompatibility characteristics.

C-reactive protein is directly related to plasminogen activator inhibitor type 1 (PAI-1) levels in diabetic subjects with the 4G allele at position -675 of the PAI-1 gene

BACKGROUND AND AIMS

C-reactive protein (CRP) has been identified as a possible factor able to promote atherosclerosis. "In vitro" studies have demonstrated that CRP induces plasminogen activator inhibitor type 1 (PAI-1) expression, suggesting a hypofibrinolytic role for CRP. As CRP and PAI-1 levels increase in type 2 diabetic subjects, we decided to study the relationship between CRP and PAI-1, and the role of the 4G/5G polymorphism of the PAI-1 gene on this relationship in a diabetic population without complications.

METHODS AND RESULTS

Two hundred and ninety-five type 2 diabetic patients (age 60.9+/-10.5 years) and 290 healthy controls (age 59.2+/-11.5 years) were enrolled. A significant correlation between PAI-1 and CRP in diabetic subjects was found (r=0.45, p<0.001), whereas no relationship was evident in the control subjects between these inflammatory markers. Multiple regression analysis highlighted that CRP is the only one significant variable of PAI-1 antigen in diabetic subjects (partial r=0.31, p<0.01). Stratifying by genotype, a positive correlation between PAI-1 and CRP in 4G/4G (partial r=0.64 p<0.001) and 4G/5G (partial r=0.47, p<0.001) subjects was found, whereas no correlation in 5G/5G was present. Multiple regression analysis confirmed the presence of this correlation in 4G/4G (partial r=0.45, p<0.001) and in 4G/5G (partial r=0.34, p=0.007) diabetic patients.

CONCLUSIONS

These findings demonstrate that CRP plays an important role in the complex mechanism regulating PAI-1 antigen in 4G diabetic carriers.

Free testosterone/cortisol ratio in soccer: usefulness of a categorization of values

AIM

The free testosterone:cortisol ratio (FTCR) is widely used for studying and preventing overtraining syndrome in various sports. The use of FTCR for following overtraining syndrome was proposed originally with two approaches: FTCR lower than 0.35x10(-3), calculated on free testosterone (FT) in nanomoles per liter (nmol/L) and on cortisol (C) in micromoles per liter (mmole/L) or a decrease of the ratio of 30% or more in comparison with the previous value. In our experience, the use of an absolute value as a threshold is not useful, whereas the evaluation of the concentrations of hormones and their ratio in comparison with previous ones is more useful. These classical approaches are not, however, sufficient to describe the various possible physiological modifications linked to training excess and/or incomplete recovery.

METHODS

We collected samples from 32 professional soccer players of an Italian First Division team, during the period July 2001-July 2003. We analyzed the values of 21 athletes during the season 2001-2002 and of 11 athletes during the season 2002-2003 (6 out of 11 were examined also during the previous one) always present when the 4 (first season) or 5 (second season) blood drawings have been performed. We applied an original, pragmatic and easy-to-use classification of FTCR values, in association with classical interpretations based on decreases of the values in comparison with previous athlete's result.

RESULTS

We used the traditional approaches in two consecutive seasons in a professional soccer team: the evaluation of the decrease >30% of the parameter in comparison with the previous value or with the basal (preseason) value are shown. The statistical differences between the FTCR values of the six athletes followed in both seasons were not significant.

CONCLUSIONS

The classification method we propose is advantageous in comparison with traditional interpretative schemes, because identify different risk categories, stratifying the interval between the values 0.35-0.8.

The exciting story of cardiac biomarkers: from retrospective detection to gold diagnostic standard for acute myocardial infarction and more

This paper reviews the history of the contribution of the laboratory medicine to clinical cardiology and discusses the most important steps in this field. Until 20 years ago, the clinical laboratory only placed at the cardiologist's disposal a few assays for the retrospective detection of cardiac tissue necrosis, such as enzymatic methods for creatine kinase and lactate dehydrogenase activities. However, in the latter part of the 20th century, highly sensitive and specific assays, such as cardiac troponins, as well as assays for markers of myocardial function, such as cardiac natriuretic peptides, rapidly changed the scenario of clinical management of patients with cardiac diseases, assigning to the laboratory a pivotal role in the overall diagnostic flow. This is witnessed by the recent incorporation of these markers into international guidelines and in the redefinition of myocardial infarction. For the foreseeable future, new serum markers of myocardial ischemic, i.e. reversible, injury or related to coronary plaque instability and disruption are expected.

Interleukin-6-174 G > C polymorphism affects the association between IL-6 plasma levels and insulin resistance in type 2 diabetic patients

Interleukin-6 (IL-6), a powerful inflammatory mediator, plays a pivotal role in the pathogenesis of insulin resistance and type 2 diabetes. Recently, the IL-6 promoter polymorphism, at position -174 (G > C), has been associated to insulin sensitivity although contrasting data have been reported. The aim of this study was to evaluate the effect of the IL-6-174 G > C polymorphism on insulin resistance. In 238 type 2 diabetic patients without diabetic complications and in 255 control subjects, age and gender-matched, we evaluated the IL-6 -174 G > C genotype, the IL-6 plasma levels and the insulin resistance by the homeostasis model assessment (HOMA). The levels of IL-6 and HOMA were not genotype-dependent and were higher in diabetic patients (p < 0.01). Control subjects, both C+ (CG + CC genotypes) and C- (GG genotype) carriers, showed IL-6 plasma levels significantly related to BMI, fasting insulin and HOMA. The same relationships were found in C+ diabetic carriers. Differently, diabetic C- carriers did not show any relationship between IL-6 levels and all the evaluated variables. Interestingly, all the correlations were dependent on BMI. These findings highlight that IL-6-174 G > C polymorphism affects insulin resistance in type 2 diabetes, where C+ carriers have an insulin resistance "IL-6-sensitive", while C- carriers do not. The identification of two categories of diabetic patients may, therefore, lead to different therapeutic strategies in the management of insulin resistance.

Plasma oxidative stress biomarkers, nitric oxide and heat shock protein 70 in trained elite soccer players

The physiological response to the physical exercise involves a number of changes in the oxidative balance and in the metabolism of some important biological molecules, including nitric oxide (NO) and heat shock proteins (Hsp 70). With the aim to optimise previous laboratory diagnostic panels, we measured the plasma concentration of reactive oxygen metabolites (ROMs), total antioxidant status (TAS), glutathione reductase (GR) activity, and NO and Hsp 70 levels in 44 elite, antioxidant-supplemented and trained soccer players and in 15 sedentary controls. Although no statistically significant difference between athletes and controls was detected in the plasma level of ROMs and TAS, soccer players showed a significantly higher plasma GR activity, NO and Hst 70 levels than those of sedentary controls. These findings suggest that the measuring of relatively novel biomarkers in sport medicine, like GR, NO and Hsp 70, in addition to the well-known and reliable assays (d-ROMs test and TAS) may be useful to a clinician to better assess and evaluate the benefits of training and/or supplementation programs.

B-type natriuretic peptide in athletes performing an Olympic triathlon

AIM

Brain natriuretic peptide (BNP) is a cardioactive molecule produced in the myocardium. BNP is a sensitive marker of cardiac failure and its measurement in blood could be useful to the diagnosis and the treatment of this disease. Sporting activities, especially endurance ones, can induce cardiac problems, owing to the high workload for the myocardium during long and ultralong heavy effort. There are 2 papers describing the behavior of BNP in endurance events. BNP was elevated in marathoners, immediately after the race and also after 4 h. We studied the behavior of BNP in the triathlon, which is a complex sport characterized by 3 different activities (swimming, cycling, running).

METHODS

We recruited 49 athletes, all males, except for 4 females; 2 athletes did not finish the race and were not included in the statistical analysis in 2 different competitions. In these subjects we measured BNP using an immunological method before and after a triathlon.

RESULTS

No statistical significance between BNP values, before and after the triathlon, was found.

CONCLUSIONS

We found no significant differences between pre- and postcompetition BNP values. Moreover, the range of values in both the blood drawings are similar of those of the general population, representing the biological variability of the analyte. The values in regularly trained athletes,, are not different from the general population and BNP is not modified by a triathlon, a typical endurance sport performance. We can underline that BNP increases in plasma are induced by heavy pathologies and are not influenced by physical activities, even strenuous ones.

Behaviour of haematological parameters in athletes performing marathons and ultramarathons in altitude ('skyrunners')

We observed athletes performing marathons and ultramarathons in altitude over several years to study the behaviour of haematological parameters in order to screen eventual paraphysiological or pathological conditions (sports anaemia). We collected samples from 124 athletes participating in seven races; 23 athletes were recruited in different races: 16 for four times, four for three times, and three for two times. The pre- and post-race values of erythrocytes, haemoglobin and packed cell volume did not show statistically significant differences in the studied athletes. The erythrocytes' indices (MCV, MCH, MCHC) and red cell distribution width (RDW) also were not significantly modified by the strenuous effort. The leukocytes were significantly increased because of immunological involvement during the endurance performance. Platelets and relative indices were not significantly modified. The stability of packed cell volume and haemoglobin in athletes performing training and races in altitude is strong evidence for the use of these parameters as an index of general health status and for illustrating possible abnormal increase because of exogenous stimulation of bone marrow. The preanalytical and analytical accuracy is crucial to assure clinical validity of the collected data: we strictly observed international recommendations in this field.

Preanalytical phase of sport biochemistry and haematology

Biochemistry and haematology are more and more important and sometimes crucial in sport medicine for diagnosing, controlling and preventing purposes. The analytical process and the global laboratory quality are heavily influenced by the preanalytical phase, including biological material collection, identification, storage and transport of the specimen, preparation for analyses of the specimen through centrifugation, freezing and thawing, aliquoting and sampling. The increasing interest of sport biochemistry should be linked to a knowledge of principal problems and pitfalls in the preanalytical phase of various parameters, commonly used in following training, diet, and performances of athletes, to avoid misinterpretation of data and to improve usefulness of biochemical investigations. We prepared a practical review of preanalytical aspects of principal analyses applied to the athletes. We include the choice of anticoagulant and its limits for haematological tests, the preparation and manipulation of specimens for hormonological investigation, especially for labile molecules, and for cardiac markers, lactate, cytokines, micronutrients, antioxidant molecules. Preanalytical phase of specimens different from blood are also showed, including urine and saliva, and some aspects of preparation of materials to be analyzed with molecular biology technology are treated. Stability of some analytes, when the parameter is fundamental for the clinical usefulness of the results, is supplied. Preparation of the subjects, however, including the possible influence of physical exercise and biological rhythms on the biochemical and haematological parameters, are not listed.

[Baropodometric examination for complete diagnosis of patients with cranio-cervico-mandibular disorders]

BACKGROUND

The aim of this study was to evaluate the relationship between craniomandibular disorders and postural alterations using baropodometric examination.

METHODS

All tests were carried out in the Department of Dentistry at Sassari University in a population of patients with cranio-cervico-mandibular disorders (CCMD) of various types and severity. A total of 10 subjects (mean age approximately 30 years) with this pathology were evaluated over 7 months. All patients were treated using the following protocol: objective functional and clinical examination, radiographic tests, occlusal treatment using acrylic resin plate, baropodometric test with static and dynamic posture assessment, with eyes open and closed, before and after treatment with orthesis.

RESULTS

An improved postural position was observed in 80% of cases, of which 30% showed an improvement in both static and dynamic posture, 20% only in static and 30% only in dynamic; these results highlighted the importance of baropodometric analysis in the correct treatment of patients with CCMD and postural disorders.

CONCLUSIONS

This study confirms the need for a holistic approach to odontostomatological disciplines and the importance of a modern preventive and/or therapeutic approach to orthodontic problems and CCMD, especially when fixed or removable biomechanical devices are used.

Multicenter evaluation of five assays for myoglobin determination

BACKGROUND

Lacking assay standardization, different myoglobin methods may produce results that differ significantly.

METHODS

A multicenter study was carried out to compare the analytical performance of five commercially available assays for myoglobin measurement. Linearity, imprecision, interferences, and method comparison were studied according to NCCLS guidelines, whereas reference values were determined following IFCC recommendations.

RESULTS

The BNA and Opus showed relatively high imprecision (all but one total CV >7.4%). Other assays showed lower CVs, but they varied among laboratories, particularly at a normal myoglobin concentration (Access, 6.0-11%; Hitachi, 3.8-5.8%; Stratus, 3.4-6.5%). Results were lower in anticoagulated samples on the Access, in heparin and citrate samples on the Stratus, and in citrate samples on the BNA and Opus, and increased in heparin and EDTA samples on the Hitachi. Use of separator gel produced results significantly lower (P <0.001) on the Hitachi and higher (P = 0.016) on the Opus. Bilirubin, turbidity, and hemoglobin had no effect on evaluated methods, but rheumatoid factor affected the Access. In method comparisons, high correlation coefficients (>/=0.98) were obtained. The Stratus gave higher results; however, the Access and BNA gave the lowest. The following upper reference limits (microgram/L) for men and women, respectively, were obtained: Access, 70 and 52; BNA, 51 and 49; Hitachi, 67 and 58; Opus, 80 and 50; and Stratus, 86 and 63.

CONCLUSION

The possibility of high imprecision and marked disagreement among commercial myoglobin assays should be carefully considered in clinical practice.

[The role of biochemical markers of myocardial damage in clinical practice: the diagnosis of infarct and risk stratification. The Intersociety Interdisciplinary Study Group of the ANMCO-SIBioC-SIMeL, Markers of Muocardial Lesions. L'Associazione Nazionale Medici Cardiologi Ospedalieri-Società Italiana di Biochimica Clinica-Società Italiana di Medicina di Laboratorio]

For many years creatine kinase (CK) and CK-MB isoenzymes were used together with the ECG to confirm the presence of myocardial infarction. During the last decade newer cardiac markers have been introduced and immunological test systems developed for their quantification. Among these new markers, a prominent role has emerged for cardiac troponins (T or I). These technological advanced assays have shown greater sensitivity compared to "conventional cardiac enzymes;, thereby identifying patients with small--at times, microscopic--infarcts who would not have met defining criteria for myocardial infarction in an earlier era. Another major advantage shown by both cardiac troponins with respect to "conventional cardiac enzymes" is their ability to predict clinical outcome over a short- or long-term follow-up in patients with acute coronary syndromes, and this appears to be particularly relevant in patients with micronecrosis, who constitute a high-risk subgroup of unstable angina patients. Recently, myoglobin has also been widely applied as a marker. Although lacking in myocardial specificity, it is the earliest marker to show an increase after coronary occlusion. Thus, the combined use of myoglobin and a cardiospecific structural protein such as troponin T or I may prove an attractive strategy for biochemical testing in chest pain patients. With the routine use of these novel cardiac markers, fascinating opportunities are now open in the field of diagnostic classification (making the World Health Organization definition of myocardial infarction obsolete) and risk stratification in chest pain patients; opportunities that were unforeseen in the era of cardiac enzymes. However, the use of these markers has also posed some important questions on: a) the best and most cost-effective diagnostic strategy in chest pain patients; b) the remaining role of cardiac enzymes; c) the therapeutic consequences of a positive test result.

The diagnostic and prognostic value of cardiac Troponin T in bypass surgery

BACKGROUND

The purpose of this study was to verify the utility of serum Troponin T (TnT) in the diagnosis of myocardial damage after coronary surgery performed using different methods of myocardial protection. The prognostic value of TnT peak for a poor postoperative course was also investigated.

METHODS

Forty-three patients were enrolled and randomised in 2 group: Group A (n. 22) receiving warm blood cardioplegia and Group B (n. 21) receiving cold blood cardioplegia. According to TnT peak levels 3 subgroups were identified: Subgroup 1 (TnT peak < than 1 ng/ml); Subgroup 2 (TnT peak between 1 and 3 ng/ml), Subgroup 3 (TnT peak >3 ng/ml). A comparison with the standard criteria for diagnosis of myocardial ischemia was performed for each subgroup of patients. A 12 months follow-up for the patients of subgroups 1 and 2 was also completed in order to evaluate the prognostic value of a higher TnT peak.

RESULTS

The overall patients subdivision in subgroup 1, 2 and 3 was 20 (46.5%), 14 (32.5%) and 9 (20.9%) respectively with no statistical difference for Group A or B. Only 7 of the patients of subgroup 3 (87%) matched the WHO diagnostic criteria for myocardial infarction. At the overall follow-up, 2 (14.28%) patients of subgroup 2, and 4 (20.0%) of subgroup 3, revealed a residual ischemia at the ECG-stress test even if none of these needed reoperation.

CONCLUSIONS

Our data confirmed the high sensitivity and specificity of TnT measurement in the diagnosis of myocardial infarction and minor myocardial damage. This study, however, failed to show any statistically significant difference of the TnT peak when using different strategies of myocardial protection. The late prognostic value of the TnT increase in the early post-operative course has to be confirmed from a further study.

Gut function and immune and inflammatory responses in patients perioperatively fed with supplemented enteral formulas

OBJECTIVE

To evaluate if the perioperative administration of a supplemented enteral formula modulates selective inflammatory and immune variables and gut function after surgery.

DESIGN

Prospective, randomized, double-blind, clinical trial.

SETTING

Department of surgery, university hospital.

PATIENTS

Forty patients with neoplasm of the colorectum or stomach.

INTERVENTION

Seven days before surgery, the patients drank 1 L/d of a control enteral formula (n = 20) or the same formula enriched with arginine, RNA, and omega-3 fatty acids (n = 20). Jejunal infusion with the same formulas was started 6 hours after operation and continued until day 7.

MAIN OUTCOME MEASURES

Immune response was determined by phagocytosis ability and respiratory burst of polymorphonuclear cells, and inflammatory response by plasma levels of C-reactive protein. Operative intestinal microperfusion, postoperative intestinal mucosa oxygen metabolism, and plasma intestinal isoenzyme of alkaline phosphatase were used as indicators of gut function. Plasma nitric oxide also was determined.

RESULTS

In the enriched group, phagocytosis ability and respiratory burst after surgery was higher (P < .01) and C-reactive protein level was lower (P < .05) than in the control group. The enriched group had higher mean (+/-SD) intestinal microperfusion (180 +/- 46 vs 146 +/- 59 perfusion units, P < .05), intestinal mucosa oxygen metabolism (pHi 7.39 +/- 0.2 vs pHi 7.33 +/- 0.1, P < .05), and 5-fold lower levels of intestinal isoenzyme of alkaline phosphatase (P < .05). Postoperative levels of nitric oxide were higher in the enriched group (P < .05, analysis of variance).

CONCLUSION

The perioperative administration of an enriched enteral formula significantly improved gut function and positively modulated postsurgical immunosuppressive and inflammatory responses.

[Aplasia and hypoplasia of the optic nerve. Comparison of 2 cases]

Hypoplasia and aplasia of the optic nerve are congenital anomalies characterized respectively by a marked volume reduction (very small papilla, often identifiable only as a rosy-yellowish area from which the retinal vessels emerge) and by the absence of the optic disk (absence of the nerve and mainly of its vessels) and of the visual functions. These anomalies are often associated with malformations of the central nervous system and of the ocular structures. The defects originate in the embryonal period due to the arrested development of the mesodermal component towards the head of the optic nerve. The aim of this study is to try to interpret the different clinical manifestations of the disease by observing two cases (a female and a male) with a clinical picture of aplasia and hypoplasia of the optic nerve respectively. Both cases presented the following clinical characteristics: developmental defects of the optic nerve, severe microcephaly, positive IgG antibodies against CMV. The association of the optic nerve defect with microcephaly is due to the embryogenic origin of the optic vescicle by prosencephalon. The resulting clinical picture is probably the outcome of an interfering process that the authors have presumed in CMV intrauterine infection, after having excluded the most frequent teratogenic agents (maternal diabetes, tabagism, intake of alcohol ad drugs). Moreover, the different degree of ocular involvement and the different time of onset of the intrauterine pathogenic insult in the two cases could account for the different clinical pictures.

Measurement of cardiac troponin T and myosin to detect perioperative myocardial damage during coronary surgery

This study evaluated the use of monitoring blood levels of the isoenzyme of creatine phosphokinase, troponin T (tnT) and myosin in the detection of perioperative myocardial damage after coronary artery surgery. Serial blood samples were collected in 24 patients undergoing myocardial revascularization. The patients were retrospectively divided into three groups: group A with no changes in their electrocardiogram; group B showing non-specific signs of perioperative myocardial infarction such as deep and permanent T wave inversion; and group C with definite electrocardiographic signs of perioperative myocardial infarction (new persistent Q-waves and loss of R-waves). Group A (n = 17) demonstrated a mean(s.d.) troponin T peak blood level of 0.64(0.35) ng/ml at 12-24 h after surgery, a myosin peak of 1030(670) mu units/l at 3-6 days afterwards, and a creatine phosphokinase isoenzyme peak of 25.8(10.6) units/l. In group B (n = 5), mean(s.d.) troponin T levels were elevated to a peak of 4.8(3.9) ng/ml 24 h after intervention, while myosin rose to 2074(340) mu units/l 3-6 days after surgery and creatine phosphokinase isoenzyme reached 57.8(38) units/l. Group C (n = 2) had a mean(s.d.) troponin T peak of 4.8(2.6) ng/ml, a myosin peak of 2404(392) mu unit/l and a creatine phosphokinase isoenzyme peak of 88.5(20) units/l. Peak values of troponin T and myosin in groups B and C were statistically different from those in group A (P < 0.001). These results suggest that troponin T and myosin are reliable indicators of perioperative myocardial damage. In particular, troponin T may allow the differentiation of reversible from irreversible myocardial injury.

Neuroblastoma IV-S in a patient with bilateral microphthalmia

Neuroblastoma, a tumor of post-ganglionic sympathetic neurons, may be associated with a variety of genetic defects and congenital malformations (1). We report a case of neuroblastoma (NB) stage IV-S (2) in an infant with bilateral microphthalmia and other ocular malformations.

Kappa light chain predominance in serum and cerebrospinal fluid from human immunodeficiency virus type 1 (HIV-1)-infected patients

We measured kappa/lambda light chain ratios of Ig and IgG in 41 serum and 34 cerebrospinal fluid (CSF) samples from 47 patients at different clinical stages of human immunodeficiency virus type 1 (HIV-1) infection and in serum and CSF samples from control subjects. Both ratios were more elevated in HIV-1 seropositive subjects than controls. The elevation was more evident in samples from asymptomatic seropositive patients (ASP) than those from patients with acquired immunodeficiency syndrome (AIDS). In addition, there was a statistically significant elevation of Ig kappa/lambda ratios in ASP CSF compared to serum. We also delineated the light chain composition of oligoclonal IgG bands (OCB) by isoelectric focusing followed by immunofixation in CSF and serum samples from selected ASP and patients with AIDS who had neurological involvement. Five of six AIDS and all seven ASP samples had IgG OCB exclusively or predominantly of the kappa type. Four IgG OCB of the lambda type and one free lambda chain band were seen in CSF from a pediatric AIDS patient. The presence of an abnormally elevated kappa/lambda ratio correlated with the presence of IgG kappa OCB (p less than 0.02). We conclude that HIV-1 infection is associated with a kappa light chain predominance and with OCB mainly composed of kappa light chains.

Detection of a case of pseudolymphocytosis due to cryoglobulins

A new type of interference of cryoglobulins on hemocytometric tests is described. The precipitation of temperature-dependent proteins produced a pseudolymphocytosis on a three-part differential leukocyte count of Coulter S-Plus VI, whereas unaffected results, identical to the microscopical count, were obtained using the cytometer Coulter VCS. The laboratory detection of cryoglobulin interference on hematological data is very important in patients with underlying diseases, where the accuracy of absolute and differential leukocyte counts is critical for follow-up. Histograms from the Coulter S-Plus VI can help detect these cases.