Romantic relationship obsessive-compulsive doubts, perfectionism, and DSM-5 personality traits in LGB people: a comparison with heterosexual individuals

Introduction

Relationship Obsessive-Compulsive Disorder is characterized by the presence of relationship-centered or partner-focused obsessions and compulsions that determine a great sense of doubt toward the partner or the relationship. Personality characteristics, including perfectionism, are involved in the development of Relationship Obsessive-Compulsive Disorder, and could predispose the individual to excessive doubts and preoccupations regarding the "adequacy of the couple" or the physical appearance of one's partner. Evidence from epidemiological research shows that the LGB community can present a high risk and prevalence of obsessive-compulsive symptoms and recent research demonstrated the usefulness of the DSM-5 personality model in understanding the personality of sexual minorities. However, further research is necessary to deepen our knowledge of the relationship between these variables in the LGB community. The aim of the present study was to compare a group of heterosexual individuals to a group of LGB individuals regarding personality traits, perfectionism, and relationship obsessive-compulsive symptoms.

Methods

A total of 200 participants, 98 in the heterosexual group and 102 in the LGB group, were enrolled in the study and completed a psychological battery comprised of the Obsessive-Compulsive Inventory-Revised, Personality Inventory for DSM-5, Relationship Obsessive-Compulsive Inventory, Partner-Related Obsessive-Compulsive Symptom Inventory, and Multidimensional Perfectionism Scale.

Results

The results show that LGB individuals tend to report greater feelings of doubt regarding the partner's love, more negative emotions (Negative Affect) and Antagonism, and greater perfectionism traits compared to heterosexual individuals.

Conclusion

These findings underline the necessity to consider the implementation of personalized interventions in clinical practice and the importance of initiating early preventive programs in sexual minority communities.

Current and future hormonal contraception in Italy: results from an Italian consensus expert meeting

BACKGROUND

Hormonal pills are among the most widely contraceptive methods used by women, despite the possible onset of different adverse events. To minimize the risk of thrombosis-related adverse events, different formulations and doses have been investigated. Micronized estradiol (E2)/nomegestrol acetate (NOMAC) 24+4 is the first monophasic combined oral contraceptive pill containing natural E2, the same steroid produced by the granulosa cells of women ovaries. This combination presents an improved effect on hemostasis and metabolism compared to ethinyl-estradiol (EE)-based products and may be considered a good option to meet women's needs in a more physiological way. Despite the benefits of E2, its use is still not so common among combined oral contraceptives (COC).

METHODS

Seventy-seven Italian gynecologists were involved and asked to answer a survey to investigate some aspects related to contraception. The results of the survey were discussed within the same gynecologists and a panel of experts during eight macro-regional meetings.

RESULTS

The survey demonstrated that clinicians dedicate 40-60% of their time to contraception and confirmed the importance of the choice of the contraceptive pill, which is mostly prescribed for contraceptive purposes. Moreover, COC containing E2 is considered as the first choice in oral contraception and meets the features of an ideal pill.

CONCLUSIONS

Italian gynecologists reported that E2-based pill presents benefits related to safety, good tolerability, and low adverse events, in particular, related to a reduced thromboembolic risk. Research market data highlight that the use of these types of COC should expand with respect to traditional compounds containing EE.

Determination of Vegetal Proteins in Milk Powder by Sodium Dodecyl Sulfate–Capillary Gel Electrophoresis: Interlaboratory Study

An interlaboratory study, with the participation of 8 laboratories, was conducted to evaluate a sodium dodecyl sulfate–capillary gel electrophoresis method for determination of adulteration of milk powder with soy and pea proteins. Calibration standards (0–8%, w/w, soy and pea protein in total protein) and adulterated skim milk powders (0–5%, w/w, soy and pea proteins in total protein) were produced. Vegetal proteins were determined after removal of milk proteins by pretreatment of the samples with tetraborate–EDTA buffer, pH 8.3. Repeatability standard deviations ranged from 9 to 15% and reproducibility standard deviations ranged from 25 to 30% in the samples containing 5% vegetal protein in total protein.

Il contributo dei batteri lattici per la presenza di melatonina nel vino rosso

La melatonina (MEL) è un'indolammina implicata nella regolazione dei cicli circadiani e che possiede attività antiossidante. La presenza di MEL è stata dimostrata nelle piante e negli alimenti con particolare attenzione agli alimenti e bevande fermentati, tra cui il vino. L'uva è una fonte di MEL e nel vino l'attività metabolica del lievito svolge un ruolo cruciale per la produzione di MEL. È stato recentemente suggerito che anche i batteri lattici (LAB) posseggano tale abilità. In questo studio è stata indagata la sintesi di MEL da parte dei LAB in condizioni enologiche e di laboratorio. Sono stati analizzati 8 vini rossi prodotti su scala industriale in 4 cantine. Inoltre, 11 ceppi di LAB sono stati inoculati in terreno sintetico simil-vino. Dai risultati ottenuti è emerso che nei vini prodotti in due delle quattro cantine è stato osservato un aumento di MEL al termine della fermentazione malolattica. Tutti i ceppi oggetto dello studio hanno prodotto MEL in condizioni di laboratorio in quantità variabile a seconda del ceppo. I risultati mettono in evidenza per la prima volta che i LAB sono capaci di rilasciare MEL sia in condizioni di laboratorio che nel vino prodotto industrialmente. The contribution of lactic bacteria on melatonin in red wine

Il difetto di luce nel vino bianco: Effetto ed evoluzione nel corso della conservazione

L'esposizione del vino bianco ad una radiazione luminosa impatta negativamente sulle caratteristiche sensoriali. Tale condizione può causare la comparsa di un'alterazione, nota come difetto di luce, causata dalla formazione di composti solforati, quali metantiolo (MeSH) e dimetildisolfuro (DMDS). Le reazioni indotte dalla luce originano dalla riboflavina (RF), un composto fotosensibile, e dalla metionina (MET). I trattamenti del vino bianco con bentonite o carbone attivo sono efficaci per rimuovere parte della RF e l'aggiunta al vino di tannini idrolizzabili limita la comparsa del difetto di luce in soluzione modello. Non è stata ancora chiarita l'evoluzione del difetto di luce nel vino bianco durante la shelf-life. In questo studio sono stati valutati gli effetti dei fenomeni foto-indotti in vino bianco dopo 24 mesi di conservazione. Il vino è stato addizionato di RF, MET e antiossidanti, quali glutatione, anidride solforosa e tannino di castagno, singolarmente ed in combinazione, esposto alla luce e conservato al buio. Come atteso, la RF è degradata in seguito all'esposizione alla fonte luminosa in tutte le condizioni saggiate. La diminuzione di MET è compresa nel range 21–38% in funzione degli antiossidanti aggiunti che, quando aggiunti singolarmente, limitano la formazione del difetto di luce come dimostra il minore livello di MeSH e DMDS presenti. I dati ottenuti suggeriscono che l'impiego di tannini da legno può essere un efficace strumento per limitare la comparsa del difetto di luce anche nel vino bianco.

Impiego di antiossidanti per limitare la comparsa del difetto di luce durante la shelf-life

Il difetto di luce è un'alterazione che può avvenire nel vino bianco dovuto alla formazione di composti solforati, quali metantiolo (MeSH) e dimetildisolfuro (DMDS). Tali composti derivano dalle reazioni foto-ossidative che coinvolgono la riboflavina (RF), un composto fotosensibile, e la metionina (MET). È stato recentemente osservato che l'aggiunta di tannini di legno limita la comparsa del difetto in soluzione modello. Non è stata ancora chiarita l'evoluzione del difetto di luce nel corso della shelf-life. In questo studio sono stati valutati i fenomeni foto-ossidativi in soluzione modello dopo 24 mesi di conservazione. La soluzione modello è stata addizionata di RF e MET, e di antiossidanti, quali anidride solforosa, glutatione e tannino di castagno, singolarmente ed in combinazione, ed esposta alla luce. Come atteso, RF è stata degradata con la luce in tutte le condizioni saggiate. Al contrario, la diminuzione di MET è dipendente dalla tipologia di antiossidante aggiunto, anche nei campioni conservati al buio. L'aggiunta degli antiossidanti limita la formazione del difetto di luce come dimostra il minore livello dei composti solforati, MeSH, DMDS and dimetil trisolfuro ed il minor punteggio ottenuto dall'analisi sensoriale. Gli antiossidanti testati possono svolgere un'azione protettiva contro la comparsa del difetto di luce.

Modulation of gonadotrophin induced steroidogenic enzymes in granulosa cells by d-chiroinositol

BACKGROUND

d-chiroinositol (DCI) is a inositolphosphoglycan (IPG) involved in several cellular functions that control the glucose metabolism. DCI functions as second messenger in the insulin signaling pathway and it is considered an insulin sensitizer since deficiency in tissue availability of DCI were shown to cause insulin resistance (IR). Polycystic ovary syndrome (PCOS) is a pathological condition that is often accompanied with insulin resistance. DCI can positively affects several aspect of PCOS etiology decreasing the total and free testosterone, lowering blood pressure, improving the glucose metabolism and increasing the ovulation frequency. The purpose of this study was to evaluate the effects of DCI and insulin combined with gonadotrophins namely follicle-stimulating hormone (FSH) and luteinizing hormone (LH) on key steroidogenic enzymes genes regulation, cytochrome P450 family 19 subfamily A member 1 (CYP19A1) and cytochrome P450 side-chain cleavage (P450scc) in primary cultures of human granulosa cells (hGCs). We also investigated whether DCI, being an insulin-sensitizer would be able to counteract the expected stimulator activity of insulin on human granulosa cells (hGCs).

METHODS

The study was conducted on primary cultures of hGCs. Gene expression was evaluated by RT-qPCR method. Statistical analysis was performed applying student t-test, as appropriate (P < 0.05) set for statistical significance.

RESULTS

DCI is able to reduce the gene expression of CYP19A1, P450scc and insulin-like growth factor 1 receptor (IGF-1R) in dose-response manner. The presence of DCI impaired the increased expression of steroidogenic enzyme genes generated by the insulin treatment in gonadotrophin-stimulated hGCs.

CONCLUSIONS

Insulin acts as co-gonadotrophin increasing the expression of steroidogenic enzymes genes in gonadotrophin-stimulated granulosa cells. DCI is an insulin-sensitizer that counteracts this action by reducing the expression of the genes CYP19A1, P450scc and IGF-1R. The ability of DCI to modulate in vitro ovarian activity of insulin could in part explain its beneficial effect when used as treatment for conditions associated to insulin resistance.

Characteristics of Menstrual and Nonmenstrual Attacks in Women with Menstrually Related Migraine Referred to Headache Centres

Aim of this study was to determine whether menstrual attacks differ from non-menstrual attacks (NMA) as regards clinical features or response to abortive treatment in women affected by menstrually related migraine (MRM) referred to tertiary care centres. Sixty-four women with MRM were enrolled in a 2-month diary study. Perimenstrual attacks were split into three groups – premenstrual (PMA), menstrual (MA) and late menstrual (LMA) – and compared to nonmenstrual ones. Perimenstrual attacks were significantly longer than NMA. No other migraine attack features were found to differ between the various phases of the cycle. Migraine work-related disability was significantly greater in PMA and MA than in NMA. Acute attack treatment was less effective in perimenstrual attacks. Pain-free at 2 h after dosage was achieved in 13.5% of MA (OR 0.41; 95% CI 0.22, 0.76) vs. 32.9% of NMA. We concluded that, in MRM, perimenstrual attacks are longer and less responsive to acute attack treatment than NMA.

The anti-Müllerian hormone (AMH) acts as a gatekeeper of ovarian steroidogenesis inhibiting the granulosa cell response to both FSH and LH

PURPOSE

Anti Müllerian Hormone (AMH) has a negative and inhibitory role in many functions of human granulosa-lutein cells (hGCs) including notoriously the reduction of the aromatase CYP19A1 expression induced by follicle-stimulating hormone (FSH). No data have been provided on the possible role of AMH in modulating the response to luteinizing hormone (LH) (alone or combined with FSH) as well as its effect on other enzymes involved in steroidogenesis including aromatase P450scc. The aim of this study was to investigate the role of AMH as regulator of the basal and stimulated steroids production by hGCs.

METHODS

Primary culture of hGCs were incubated with hormones AMH, LH, and FSH, alone or in combination. The CYP19A1 and P450scc messenger RNA (mRNA) expression, normalized by housekeeping ribosomal protein S7 (RpS7) gene, was evaluated by reverse transcriptase quantitative PCR (RT-qPCR). Each reaction was repeated in triplicate. Negative controls using corresponding amount of vehicle control for each hormone treatment were performed.

RESULT

AMH did not modulate the basal mRNA expression of both aromatase genes at any of the concentrations tested. Meanwhile, the strong mRNA induction of CYP19A1 and P450scc generated by a 24-h gonadotropin treatment (alone and combined) was suppressed by 20 ng/ml AMH added to culture medium.

CONCLUSIONS

These findings contribute in clarifying the relationship between hormones regulating the early phase of steroidogenesis confirming that AMH is playing a suppressive role on CYP19A1 expression stimulated by gonadotropin in hGCs. Furthermore, a similar inhibitory effect for AMH was observed on P450scc gene expression when activated by gonadotropin treatment.

Effect of oral contraceptives containing estradiol and nomegestrol acetate or ethinyl-estradiol and chlormadinone acetate on primary dysmenorrhea

OBJECTIVE

To study the three cycles effect on primary dysmenorrhea of the monophasic 24/4 estradiol/nomegestrol acetate (E2/NOMAC) and of the 21/7 ethinyl-estradiol/chlormadinone acetate (EE/CMA) oral contraceptive. The tolerability and the effect of both preparations on metabolism and health-related quality of life were also evaluated.

DESIGN

Prospective observational cohort study.

SETTING

Tertiary gynecologic center for pelvic pain.

PATIENTS

Subjects with primary dysmenorrhea requiring an oral contraceptive, who spontaneously selected either E2/NOMAC (n = 20) or EE/CMA (n = 20).

MAIN OUTCOME MEASURES

Visual Analogue Scale (VAS) score for dysmenorrhea, Short Form-36 questionnaire for health-related quality of life, lipoproteins and days of menstrual bleeding (withdrawal bleeding during oral contraceptive).

RESULTS

Mean age and body mass index (BMI) were similar between the two groups. The final analysis was performed on 34 women, 15 in E2/NOMAC and 19 in EE/CMA group. Compliance with treatment was significantly higher with EE/CMA (100%) than E2/NOMAC (75%) (p = 0.02). Both treatments significantly (p < 0.0001) reduced VAS of primary dysmenorrhea, similarly (E2/NOMAC by a mean of 74.7%, EE/CMA by a mean of 78.4%; p = 0.973). Only E2/NOMAC significantly increased SF-36 score (p = 0.001), both in physical (p = 0.001) and mental domains (p = 0.004). The mean number of days of menstrual bleeding was significantly reduced in E2/NOMAC group (from 4.86 ± 1.20 d to 2.64 ± 1.59 d, p = 0.0005 versus baseline, p = 0.007 versus EE/CMA group). BMI did not vary in either group. E2/NOMAC did not change lipoproteins and apoproteins while EE/CMA increased total cholesterol (p = 0.0114), HDL-cholesterol (p = 0.0008), triglycerides (p = 0.002), apoprotein-A1 (Apo-A1; p = 0.0006) and apopoprotein-B (Apo-B; p = 0.008), decreasing LDL/HDL ratio (p = 0.024).

CONCLUSIONS

Both oral contraceptives reduced similarly primary dysmenorrhea, with E2/NOMAC also reducing withdrawal bleedings and being neutral on lipid metabolism.

Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study

PURPOSE

to compare the baseline characteristics and chance of live birth in the different categories of poor responders identified by the combinations of the Bologna criteria and establish whether these groups comprise a homogenous population.

METHODS

database containing clinical and laboratory information on IVF treatment cycles carried out at the Mother-Infant Department of the University Hospital of Modena between year 2007 and 2011 was analysed. This data was collected prospectively and recorded in the registered database of the fertility centre. Eight hundred and thirty women fulfilled the inclusion/ exclusion criteria of the study and 210 women fulfilled the Bologna criteria definition for poor ovarian response (POR). Five categories of poor responders were identified by different combinations of the Bologna criteria.

RESULTS

There were no significant differences in female age, AFC, AMH, cycle cancellation rate and number of retrieved oocytes between the five groups. The live birth rate ranged between 5.5 and 7.4 % and was not statistically different in the five different categories of women defined as poor responders according to the Bologna criteria.

CONCLUSION

The study demonstrates that the different groups of poor responders based on the Bologna criteria have similar IVF outcomes. This information validates the Bologna criteria definition as women having a uniform poor prognosis and also demonstrates that the Bologna criteria poor responders in the various subgroups represent a homogenous population with similar pre-clinical and clinical outcomes.

Individualization of the FSH starting dose in IVF/ICSI cycles using the antral follicle count

Background

The FSH starting dose is usually chosen according to women’s age, anamnesis, clinical criteria and markers of ovarian reserve. Currently used markers include antral follicle count (AFC), which is considered to have a very high performance in predicting ovarian response to FSH. The objective of the present study to elaborate a nomogram based on AFC for the calculation of the appropriate FSH starting dose in IVF cycles.

Methods

This is a retrospective study performed at the Mother-Infant Department of Modena University Hospital. IVF patients (n=505) were subjected to blood sampling and transvaginal ultrasound for measurement of serum day3 FSH, estradiol and AFC. The variables predictive of the number of retrieved oocytes were assessed by backwards stepwise multiple regression. The variables reaching the statistical significance were then used in the calculation for the final predictive model.

Results

A model based on age, AFC and FSH was able to accurately predict the ovarian sensitivity and accounted for 30% of the variability of ovarian response to FSH. An FSH dosage nomogram was constructed and overall it predicts a starting dose lower than 225 IU in 50.2% and 18.1% of patients younger and older than 35 years, respectively.

Conclusions

The daily FSH dose may be calculated on the basis of age and two markers of ovarian reserve, namely AFC and FSH, with the last two variables being the most significant predictors. The nomogram seems easily applicable during the daily clinical practice.

Hormonal and ultrasound markers of ovarian function in a woman with a balanced 1;11 translocation

OBJECTIVE

To present a case of a poor responder woman with a rare balanced autosomal translocation.

DESIGN

Case report.

SETTING

Infertility center in a university teaching hospital.

PATIENT(S)

A 34-year-old white woman with primary infertility.

INTERVENTION(S)

Laboratory and ultrasound evaluation, karyotype analysis, ovarian stimulation with gonadotropins.

MAIN OUTCOME MEASURE(S)

Markers of ovarian reserve and ovarian response to gonadotropin stimulation.

RESULT(S)

The patient was a carrier of a balanced translocation (1;11) (q23;p11.2). The hormone ovarian reserve markers (FSH, anti-Mullerian hormone, inhibin B) were within the normal range. The antral follicle count (AFC) was measured twice and only in one occasion did it reach the lower limit of the normal range. Furthermore, the patient had regular menstrual cycles. However, ovarian response to the administration of a maximal dose FSH was extremely poor.

CONCLUSION(S)

Patients with balanced autosomal translocations should be counseled regarding their increased risk for poor response even if markers of ovarian reserve are in the range of normality.

Age-specific nomogram for the decline in antral follicle count throughout the reproductive period

OBJECTIVE

To investigate the relationship between antral follicle count (AFC) and chronological age and to establish normal values for AFC in women with regular menstrual cycles.

DESIGN

Cross-sectional study.

SETTING

University hospital.

PATIENT(S)

Four hundred fifteen premenopausal women were recruited for the study. Data from 362 patients were available for the statistical analysis.

INTERVENTION(S)

AFC was measured by transvaginal ultrasound examination.

MAIN OUTCOME MEASURE(S)

Estimating the relationship between AFC and age and developing the AFC nomogram.

RESULT(S)

The analysis showed a linear decline in AFC with age; for every year increase in age, the median AFC decreases by 0.4. The AFC corresponding to the 5th, 25th, 50th, 75th, and 95th centiles for each age have been calculated.

CONCLUSION(S)

A linear relationship of AFC to age was found. For the first time, a nomogram reporting normal and interquartile values for AFC, age by age, throughout the reproductive period has been provided. Until now, the interpretation of the measurement was mainly based on the individual experience of the operator, because no normative data were present. Therefore, the establishment of a nomogram of AFC values is the first step to counsel patients on a scientific basis.

Inactivation of wine spoilage yeasts Dekkera bruxellensis using low electric current treatment (LEC)

AIMS

The objective of this study was to investigate the inactivation of a selected yeast Dekkera bruxellensis strain 4481 in red wine by application of low electric current treatment (LEC).

METHODS AND RESULTS

LEC (200 mA) was applied for 60 days to a red wine, Montepulciano d'Abruzzo, in an alternative strategy to the SO(2) addition during wine storage. The LEC effect on both cell activity and microflora viability was assessed. LEC decreased significantly the survival viable cells and increased the death rate of D. bruxellensis strain 4481 yeast. A final comparison was made of the main physico-chemical parameters of the wine after the different treatments. The study suggests the importance of an appropriate LEC treatment which limits wine deterioration in terms of off-flavours synthesis.

CONCLUSIONS

The results demonstrate that the growth of undesirable Dekkera can be inhibited by low voltage treatment; LEC was shown to be useful to prevent wine spoilage and has the potential of being a concrete alternative method for controlling wine spoilage.

SIGNIFICANCE AND IMPACT OF THE STUDY

Wine spoilage can be avoided by preventing the growth of undesirable Dekkera yeasts, through the effective use of LEC in the winemaking process.

Embryo quality and implantation rate in two different culture media: ISM1 versus Universal IVF Medium

OBJECTIVE

To compare the outcome of two different culture media marketed by the MediCult AS Company (Jyllinge, Denmark)-Universal IVF Medium and ISM1 Medium culture-which, in addition to glucose, pyruvate, and energy-providing components, also contain amino acids, nucleotides, vitamins, and cholesterol.

DESIGN

Laboratory and retrospective clinical study.

SETTING

University teaching hospital.

PATIENT(S)

A total of 726 patients, undergoing IVF-intracytoplasmic sperm injection procedure, comparable in mean age range, oocyte retrieval, and infertility indication, were included in the study. Laboratory quality and standard procedures were maintained unaffected.

INTERVENTION(S)

Oocyte retrieval, different embryo culture media.

MAIN OUTCOME MEASURE(S)

Embryo quality, ongoing pregnancy, and implantation rate.

RESULT(S)

The frequency of good-quality embryos (79% vs. 74%) and the percentages of ongoing pregnancy (27.5% vs. 18%) and implantation rate (15% vs. 10%) were significantly higher in the group treated with ISM1 Medium rather than Universal IVF Medium.

CONCLUSION(S)

ISM1 Medium culture seems to improve the performance of embryonic growth and development, as well as increasing the percentage of pregnancy.

Insulin sensitivity and lipid metabolism with oral contraceptives containing chlormadinone acetate or desogestrel: a randomized trial

BACKGROUND

Second-generation and third-generation oral contraceptives containing 30 mcg or more of ethinylestradiol (EE) decrease insulin sensitivity (SI). In this study, we investigated whether SI is decreased by contraceptives containing lower doses EE or by progestins with antiandrogenic properties.

STUDY DESIGN

Twenty-eight young healthy women were randomly allocated to receive 20 mcg of EE and 150 mcg of desogestrel (DSG) (n=14) or 30 mcg of EE and 2 mg of chlormadinone acetate (CMA) (n=14) for 6 months. SI and glucose utilization independent of insulin (Sg) were investigated by the minimal model method. Lipid modifications were also analyzed.

RESULTS

SI decreased with EE/DSG (7.09+/-1.4 vs. 4.30+/-0.91; p=.04; n=12), but not with EE/CMA (5.79+/-0.93 vs. 6.79+/-1.1; p=.48; n=12). SI modifications observed in the two groups were significantly different (-2.79+/-1.15 vs. 1.0+/-1.38; p=.05). Sg did not vary with either treatment. The response of C-peptide to glucose increased, but significantly so only with EE/CMA (p=.01). The C-peptide/insulin response increased with both EE/DSG (p=.05) and EE/CMA (p=.04). High-density lipoprotein (HDL) cholesterol (p=.02) and triglycerides (p=.02 and p=.01) increased in both groups, but HDL/low-density lipoprotein cholesterol (p=.02), apoprotein A1 (Apo-A1) (p=.04) and Apo-A1/apoprotein B (p=.048) increased significantly only with EE/CMA.

CONCLUSIONS

The present study confirms that DSG, even when associated with low EE dose, decreases SI. By contrast, EE/CMA does not deteriorate SI and induces a favorable lipid profile.

Levonorgestrel administration in emergency contraception: bleeding pattern and pituitary-ovarian function

BACKGROUND

This study was conducted to evaluate the effects of levonorgestrel administration for emergency contraception (EC) on bleeding pattern and pituitary-ovarian function.

STUDY DESIGN

In 69 women with a reported stable menstrual cycle length of 24-34 days, we investigated bleeding patterns following EC administration in the follicular (n=26), periovulatory (n=14) and luteal (n=29) phase. In a subgroup of 8 women, hormonal evaluation and ultrasonography were performed.

RESULTS

EC taken in the follicular, but not in the periovulatory or luteal phase, significantly shortened cycle length by 10.9+/-1 days. The subsequent cycle was not affected. EC taken in the late preovulatory phase, prior to the gonadotrophin surge, suppressed ovulation (n=7), while ovulation was not blocked when EC was given during an ongoing luteinizing hormone (LH) pulse (n=1).

CONCLUSIONS

Our data indicate that EC given before the onset of the luteinizing hormone (LH) surge inhibits ovulation and hastens the end of the current menstrual cycle. Subsequently, the length of the following menstrual cycle returned as prior to treatment. By contrast, levonorgestrel administered after the expected ovulation has no effect on menstrual cycle length.

[Ovulation induction in anovulatory women]

Ovulation induction therapy is administered to stimulate follicular growth and induce ovulation in anovulatory infertile women. In anovulatory women with polycystic ovary syndrome, the treatment of choice is clomiphene citrate, whereas in clomiphene nonresponders, gonadotrophins are given as secondary therapy. Currently, insulin-sensitizing agents are used in the treatment of polycystic ovary syndrome to restore menstrual cyclicity. In selected patients, laparoscopic drilling has also been suggested. In anovulatory patients affected with hypogonadotropic hypogonadism, treatment is based on gonadotrophin replacement therapy or pulsatile gonadotrophin-releasing hormone infusion. In ovulation induction therapy the clinician's attention should be directed at restoring normal ovary function. When pharmacotherapy is required, monofollicular growth should be induced to reduce the risk of multiple pregnancy.

Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology

BACKGROUND

Recently, a new marker, the anti-Müllerian hormone (AMH), has been evaluated as a marker of ovarian response. Serum AMH levels have been measured at frequent time-points during the menstrual cycle, suggesting the complete absence of fluctuation. The aim of this study was to evaluate whether serum AMH measurement on any day of the menstrual cycle could predict ovarian response in women undergoing assisted reproductive technology (ART).

METHODS

This study included 48 women attending the IVF/ICSI programme. Blood withdrawal for AMH measurement was performed in all the patients independently of the day of the menstrual cycle.

RESULTS

Women in the lowest AMH quartile (<0.4 ng/ml) were older and required a higher dose of recombinant FSH than women in the highest quartile (>7 ng/ml). All the cancelled cycles due to absent response were in the group of the lowest AMH quartile, whereas the cancelled cycles due to risk of ovarian hyperstimulation syndrome (OHSS) were in the group of the highest AMH quartile. This study demonstrated a strong correlation between serum AMH levels and ovarian response to gonadotrophin stimulation.

CONCLUSION

For the first time, clinicians may have a reliable serum marker of ovarian response that can be measured independently of the day of the menstrual cycle.

Effect on insulin sensitivity of Implanon vs. GnRH agonist in women with endometriosis

OBJECTIVES

To evaluate the influence of two medical treatments for endometriosis on insulin sensitivity.

STUDY DESIGN

After surgery, 26 women with endometriosis were randomly allocated to a 6-month treatment with a GnRH agonist (Leuprorelin 3.75 mg/28 days) or a subdermal progestin implant (etonogestrel 68 mg). Insulin sensitivity (SI) and glucose utilization independent of insulin (Sg) were investigated at baseline and after 6 months by a frequently sampled intravenous glucose tolerance test (FSIGT) associated with the minimal model method.

RESULTS

Both therapies tended to decrease SI, but the effect did not reach statistical significance in the GnRH agonist group (5.43+/-1.29 vs. 3.99+/-0.8) and was significant in the etonogestrel group (5.74+/-1.12 vs. 3.95+/-0,78; p=.046). Sg, fasting glucose, insulin, C-peptide and C-peptide/insulin were not modified by either treatment.

CONCLUSIONS

The modifications of glucose-insulin metabolism induced by the GnRH agonist are of no relevance for the short-term use of this molecule. Even if the modification induced by the etonogestrel implant is subtle and of no major impact, it should be taken into consideration for the long-term treatment of individuals with abnormalities of glucose-insulin metabolism.

Effects of two different oral contraceptives on homocysteine metabolism in women with polycystic ovary syndrome

PURPOSE

This study was conducted to evaluate the effects of two different oral contraceptives (OCs) on homocysteine (Hcy) metabolism in 20 women with polycystic ovary syndrome (PCOS).

METHODS

Women were randomly allocated to receive either the biphasic OC containing 40/30 mug ethynylestradiol (EE)+25/125 mug desogestrel (DSG; n=10) or the monophasic OC containing 35 mug EE and 2 mg cyproterone acetate (CPA; n=10). Investigations were performed before and after 6 months of treatment. Fasting vitamin B(12), folate, Hcy and insulin sensitivity (SI), and glucose utilization independent of insulin (Sg), by the minimal model method, were evaluated.

RESULTS

Folate and vitamin B(12) were not significantly modified by either OC. EE/DSG decreased SI (2.53+/-0.35 vs. 1.68+/-0.45; p<.05), without modifying Hcy (9.54+/-0.7 micromol/L vs. 9.18+/-0.6 micromol/L). EE/CPA improved SI (1.47+/-0.38 vs. 3.27+/-0.48; p<.04) and decreased Hcy (9.8+/-1.9 micromol/L vs. 7.9+/-0.9 micromol/L; p<.05). This study indicates that in women with PCOS, EE/CPA, but not EE/DSG, improves IS and decreases fasting Hcy.

Electroencephalographic background desynchronization during cerebral blood flow reduction

OBJECTIVE

The aim of this study is to evaluate the usefulness of a spectral function detecting cerebral hypoperfusion.

METHODS

Continuous electroencephalographic monitoring was employed during 47 consecutive carotid endarterectomies. Patients were assigned to 3 different groups according to the entity of electroencephalographic changes during carotid clamping (major changes: group A; moderate changes: group B; no change: group C). The desynchronization function, indicating the reduction of the 8-15 Hz band power, and the desynchronization index were calculated.

RESULTS

Group A function decreased within 20s from clamping, with a constant slope (7.14). Desynchronization indexes were: 76.85% (group A), 40.23% (group B) and 15.29% (group C). Difference among groups was statistically significant (P < 0.0001). A case of syncope due to asystole is also reported, showing the same pattern in the descending phase of the function.

CONCLUSIONS

The stereotyped time course of the desynchronization function describes the cerebral reaction to significant blood flow reduction. Values of desynchronization index exceeding 65% seem to correctly detect patients with cerebral hypoxic risk.

SIGNIFICANCE

The analysis of the 8-15 Hz band desynchronization is helpful in the evaluation of cerebral hypoperfusion during carotid endarterectomy. This method could be employed in monitoring different clinical situations of ischemia.

Myeloid sarcoma occurring in the maxillary gingiva: a case without leukemic manifestations

Myeloid sarcoma (MS) is a localized extramedullary mass of immature granulocytic cells that usually occurs in patients with acute myeloid leukemia (AML) or myeloproliferative disorders. It may rarely precede peripheral blood or bone marrow involvement, presenting a diagnostic challenge. Although MS may be found in any location, an intraoral occurrence is rare. In this report we describe a rare case of a patient with nonleukemic MS of the maxillary gingiva. The histologic specimen was first interpreted as non-Hodgkin's lymphoma. The correct diagnosis was reached after extensive immunohistologic studies. The malignant cells were myeloperoxidase positive, lysozyme positive, CD45+, CD68+, CD3-, CD10-, CD19-, CD20-, CD30-, CD34-, CD56-, CD79a-, S100-, and chloroacetate esterase negative. Induction therapy with FLAND (fludarabine, Ara-C, mitoxantrone, and dexamethasone) was started, but the patient did not achieve a remission. Some weeks later, the patient presented pleural effusion and paralysis of the seventh cranial nerve on the left side. She died a few days later. The present case indicates the importance of a correct initial diagnosis for adequate therapy, which is often delayed because of a high misdiagnosis rate. If the MS is treated without intensive chemotherapy for AML as soon as possible, the prognosis will be poor.

Mare milk nitrogen fractions during lactation and determination by reversed-phase HPLC of the major whey proteins

The aim of this research was to describe the changes of the nitrogen fractions in milk of Haflinger nursing mares and in particular to determine the whey protein content and distribution, and their evolution throughout the first 6 mo of lactation. Samples were collected by hand-milking on days 4, 20, 40, 60, 80, 120, 150 and 180 post-partum. Nitrogen fractions were determined by Kjeldahl on 80 samples from 10 mares, while HPLC separation of whey proteins was conducted on 40 samples from 5 mares. The total N, casein N, and true whey protein N contents showed a statistically significant decrease from day 4 to day 40, and then remained unvaried. In general, the nitrogen distribution of mare’s milk significantly changed between day 4 and day 20 and then remained almost unchanged until day 180 (except for the day 150 value, which showed a statistically significant increase for CN × 100/TN). β-Lactoglobulin and serum albumin contents showed a marked reduction, of 27 and 45.5%, respectively, between day 4 and day 20, and then remained unchanged; α-lactalbumin and immunoglobulins contents had a reduction of 24.7 and 38.3%, respectively, between day 4 and day 20, and another decrease between day 20 and day 40, of 20 and 32.8%, respectively. All whey proteins, expressed as a percentage on the total sum of the four whey proteins considered, did not vary significantly during lactation. However, the sum on the two whey proteins of mammary gland origin (β-Lg + α-La) increased between day 4 and day 20 by 6.3%, and between day 20 and day 40 by 3.8%; the sum of the whey proteins of blood origin (SA + Ig) showed an opposite trend, with a decrease by 14.5% between day 4 and day 20 and by 11% between day 20 and day 40. Key words: Mare’s milk, lactation stage, whey protein distribution, reversed-phase HPLC

Heterotopic ossification after hip surgery in cerebral palsy

Heterotopic ossification is a post-surgery complication occasionally observed in patients with infantile cerebral palsy. In the majority of the cases such lesions are found at the hip after surgery on the skeleton and the soft tissues. At our Institute in the last five years, this complication has been observed four times, in 39 patients, who underwent mainly soft tissue releases because of flexion and adduction contracture of the hip. In these cases, as in a further patient with myelomeningocele, the periarticular heterotopic ossification appeared in the hip after tenotomy of the ilio-psoas at the lesser tronchater associated to other surgical procedures. Conversely, no cases of ossification have been found after tenotomy of the adductors or the gracilis or selective tenotomy of the psoas at the pelvic brim. The exact causes of this complication are still unclear, but after an analysis of the literature and patient history it can be hypothesised that it may be related to the surgical procedures carried out.

Delayed hemolytic transfusion reaction due to anti-S antibody in patient with anti-Jk a autoantibody and multiple alloantibodies

We describe the case of a 60-year-old woman with a delayed hemolytic transfusion reaction (DHTR). She had a history of an ulcerative colitis, blood transfusion because of rectal bleeding, and surgical removal of descendent and sigmoid colon. At admission, laboratory data showed Hb 6.3 g/dL, reticulocytes 120 x 10(9)/L, serum total bilirubin 1.2 mg/dL (direct bilirubin: 0.2 mg/dL). Pretransfusion antibody screening procedures were positive. A monospecific autoanti-Jk(a) and three alloantibodies (anti-c, -E, -K) were identified by immunohematologic studies. The patient received two units of crossmatch compatible concentrated red blood cells. Six days later biochemical serum values showed Hb 6.2 g/dL, LDH 975 I.U./L and total bilirubin 2.95 mg/dL (direct 0.35 mg/dL). Crossmatches with red cell suspension of transfused blood units and a post-transfusion serum were repeatedly positive. Laboratory tests showed the presence of anti-S alloantobody in the serum and eluate. Moreover, pre-transfusion serum of the patient was retrospectively retested: anti-S was not detected. These data suggested a DHTR. The present case is unusual and interesting because of the association of a rare autoanti-Jk(a), non responsible for anemia, and four alloantibodies of which anti-S involved in a DHTR.

Direct or reverse correlations within the expression of activation, differentiation or T-B cooperation molecules on chronic lymphocytic leukemia B cells

AIM

B-cell chronic lymphocytic leukemia (B-CLL) is characterized by homogeneous coexpression of CD19, CD23 and CD5, and poor expression of membrane Ig. The aim of this study was to evaluate, in B-CLL patients and in healthy subjects by flow cytometry, B cell expression of surface molecules involved in cell activation, differentiation, T-B cooperation and apoptosis.

METHODS

The study population consisted of 29 patients (16 men and 13 women; mean age: 66.5 years) with B-CCL. The control group consisted of 16 sex- and age-matched healthy subjects. The results are reported as percentages and mean fluorescence intensity (MFI) of CD19+ cells coexpressing each analyzed molecule.

RESULTS

We found that the lymphocyte activation markers, CD69, CD25 and CD11c, were more expressed in B-CLL patients than controls. CD38 and CD95 expressions were higher on normal B lymphocytes than leukemic B cells. Finally, CD80 and CD86, molecules involved in T-B cooperation, showed an inverse expression between lymphocytes of B-CLL patients and healthy subjects. CD80 was higher on normal than leukemic B cells, while CD86 expression was higher on CLL B cells. Linear regression analysis showed a positive correlation between CD80 and CD95 expression on leukemic B cells; a reverse correlation was observed between CD69 and CD11c.

CONCLUSION

These results suggest that common mechanisms may regulate the simultaneous expression of CD80 and CD95 or the reverse expression of CD69 and CD11c, respectively, in different stages of B cell activation and/or differentiation.

Hormone supplementation differently affects migraine in postmenopausal women

OBJECTIVE

To evaluate the effects of three schemes of oral hormone replacement therapy (HRT) on migraine course in postmenopausal women.

METHODS

Thirty-eight patients presenting for clinical evaluation of menopausal status and suffering from migraine were enrolled. The observational period lasted 7 months, during which women filled in a daily diary with the clinical features of headache attacks and analgesic use. We evaluated climacteric symptoms, anxiety and depression. After a 1-month run-in period, women were assigned to one of three regimens of HRT: estradiol hemihydrate 1 mg/day plus norethisterone 0.5 mg/day for 28 days, in a continuous combined scheme; oral conjugated estrogens 0.625 mg/day for 28 days plus medroxyprogesterone acetate 10 mg/day in the last 14 days, in a sequential continuous scheme; and estradiol valerate 2 mg/day for 21 days plus cyproterone acetate 1 mg/day from day 12 to 21 in a sequential cyclical scheme. Follow-up evaluations were performed at 3 and 6 months.

RESULTS

During the run-in period, the three subgroups of patients were similar as far as the features of migraine are concerned. Overall, a progressive increase in attack frequency (from 2.2 +/- 1.0 to 3.8 +/- 1.3, P<.001), days with headache (from 3.4 +/- 1.3 to 4.9 +/- 1.9, P<.001), and analgesic consumption (from 3.4 +/- 1.3 to 5.6 +/- 2.2, P<.001) was observed after 6 months. Duration of attacks decreased (from 18.1 +/- 7.4 to 13.6 +/- 4.2 hours, P =.005), whereas severity worsened (from 1.9 +/- 0.2 to 2.1 +/- 0.2, P<.001). The increase in number of days with headache and number of analgesics used was smaller in the group receiving the continuous combined regimen than in the other two groups.

CONCLUSION

Although HRT typically will lead to some worsening of headache syndrome, estradiol hemihydrate plus norethisterone given in a combined continuous scheme was the regimen best tolerated by our patients.

Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease

Twenty-seven subjects suffering from peripheral occlusive arterial disease (POAD, clinical stage II-III according to Fontaine) were enrolled in this study to evaluate the effect of oxygen-ozone therapy upon hemorheological parameters and hemoglobin-oxygen affinity in patients with POAD. All patients underwent a major ozonized autohemotransfusion consisting of the slow reinfusion of 100 ml of autologous blood, previously exposed to a O(2)-O(3) mixture in a glass box for 10 min. Whole blood viscosity, erythrocyte filterability, hematocrit, and fibrinogen levels were assessed at the basal time and 30 min after the reinfusion of ozonized blood. At the same time p50 standard (p50std) values (an indicator of hemoglobin-oxygen affinity) and plasma values of malonyl dialdehyde (MDA, an indicator of lipid peroxidation) were evaluated. At the baseline, patients had significantly higher ( p<0.05- p<0.001) whole blood viscosity, MDA, and p50std values and significantly lower blood filterability ( p<0.01) as compared with 20 matched healthy volunteers (controls). Thirty minutes after the end of a major autohemotransfusion, whole blood viscosity significantly decreased ( p<0.01). This was accompanied by a significant fall in plasma fibrinogen level ( p<0.01) with no change in hematocrit. Blood filterability, MDA plasma level, and p50std values increased significantly at the same time ( p<0.01- p<0.005). The 2,3-DPG value did not change significantly. No significant changes occurred when the same patients received a non-ozonized autohemotransfusion (control test). In conclusion, ozonized autohemotransfusion may be useful to improve both the poor rheological properties of the blood and the oxygen delivery to tissues in patients suffering from POAD.

Effects of beta-endorphin and met-enkephalin on platelet activity

In the present study, beta-endorphin and met-enkephalin were tested for their antiplatelet activity in human platelet-rich plasma (PRP). Blood samples were obtained from 15 healthy subjects. The results of the study show that these two endogenous opioids (200 pg/ml final concentration) reduce platelet aggregation when it is induced by ADP at low dose (0.5 microM). It is likely due to conformational changes on the platelet membrane that cause a non-specific decreased susceptibility to platelet-aggregating agonists.

Biclonal gammopathy and platelet antibodies in a patient with chronic hepatitis C virus infection and mixed cryoglobulinemia

The presence of biclonal gammopathy [immunoglobulin (Ig)Mk + IgAlambda] and platelet antibodies in a patient with chronic hepatitis C virus (HCV) infection is reported. A type-II cryoglobulinemia (IgMk and polyclonal IgG) has also been detected. The IgAlambda monoclonal component still persists after removal of the cryoprecipitate. Two populations of atypical lymphoid cells with plasmocytoid features in bone marrow have been detected. They express IgM with k restriction and IgA with lambda restriction, respectively. These cells are CD19+, CD5+, bc12+, and Ki67-. Liver biopsy shows lymphoid infiltrates with features of B follicles. Thrombocytopenia with platelet antibodies but without splenomegaly is also present. This case is interesting because two hematologic extrahepatic manifestations simultaneously occur in a patient with HCV infection. Moreover the association between HCV and biclonal gammopathies has never been reported.

Computer-assisted EEG monitoring during carotid endarterectomy

The purpose of this study was to develop a reliable method of EEG analysis during carotid endarterectomy. EEGs of 104 patients under general anesthesia were processed by three different methods: a) "on-line" visual analysis during surgery, b) "off-line" visual analysis in laboratory, and c) computer analysis. To identify pathological EEGs, variability and asymmetry indexes of the 0.5-3.5 Hz and 8-15 Hz bands, absolute power and variability indexes of spectral edge frequency (SEF), and main dominant frequency were evaluated. On-line visual analysis showed clamp-related modifications in 29 EEGs (27.9%). Off-line visual analysis detected 24 pathological EEGs (23.1%): 18 with major changes and 6 with moderate changes. Computer analysis showed 21 EEGs (20.19%) with at least one altered index and 7 (6.7%) with altered variability for both SEF and 8-15 Hz power. The statistical analysis was significant for SEF variability and for 8-15 Hz power variability and asymmetry (P < 0.0001, analysis of variance test). While SEF and 8-15 Hz power variability did not appear influenced by anesthesia and single electrode artifacts, 8-15 Hz power asymmetry index was confounded by the presence of contralateral internal carotid occlusion. The data show that the use of these spectral indexes adds objective information to visual analysis, supporting and making easier intraoperative strategies. Their routine clinical use does not involve additional costs remaining technical requirements unchanged compared to traditional recording.

Improved method for the determination of furosine in food by capillary electrophoresis

A previously described method for determination of furosine by capillary zone electrophoresis in food has been improved for greater accuracy and sensitivity. Acid-hydrolyzed samples are subjected to solid phase extraction; then they are dried and redissolved before injection. The electrophoresis separation is performed in a fused silica capillary tube (50 microns inside diameter) with an extended-path-length detection cell using a 3-(N-morpholino)-2-hydroxypropanesulfonic acid solution at pH 7.0 as run buffer. The in-laboratory repeatability was within +/- 7.1% at the 95% confidence level when the amount of furosine ranged between 8 and 250 mg per 100 g protein. The values of both repeatability and sensitivity fulfill the requirements stated in the EU and Italian regulations for furosine determination in pasteurized milk and Mozzarella cheese. The data obtained on 48 different food samples including heat-treated milk, cheeses, and durum wheat products were comparable with those obtained by an HPLC method and proved to be accurate for furosine values up to at least 400 mg per 100 g protein. The furosine values found in cultured fresh cheese samples suggest that the use of this furosine index holds promise for the characterization of this type of cheese.

Effect of insulin on blood rheology in non-diabetic subjects and in patients with Type 2 diabetes mellitus

We evaluated the effect of insulin on platelet function, blood viscosity, and filterability in healthy subjects and in patients with Type 2 (non-insulin-dependent) diabetes mellitus. Fifteen diabetic patients were free from cardiovascular complications (group A), while the other 15 patients had both clinical and measured evidence of coronary or peripheral vascular disease (group B); 15 non-diabetic subjects served as controls. On blood samples taken without stasis, maximal platelet aggregation to 1.25 micromol l(-1) ADP, blood and plasma viscosity, and blood filterability were measured in basal conditions, and after incubation of blood, plasma or platelet-rich plasma with insulin at two physiological concentrations (120 and 480 pmol l(-1)). Compared with healthy subjects, the diabetic patients of group B had higher values of blood (p < 0.01) and plasma (p < 0.05) viscosity, and platelet aggregation response to ADP (p < 0.01), as well as lower values of blood filterability (p < 0.01). The diabetic patients of group A had values intermediate between normal subjects and the patients of group B. In non-diabetic subjects, insulin significantly decreased platelet aggregation and blood viscosity at low shear rates (22.5 s(-1)) (p < 0.01 for both), and had no significant effects on other parameters. In the diabetic patients of group A, insulin decreased blood viscosity at high (225 s(-1)) rates of shear (p < 0.01) and increased blood filterability (p < 0.01). The effects of insulin were not dose-related. In the diabetic patients of group B, none of the parameters evaluated was significantly influenced by insulin. Type 2 diabetic patients present many abnormalities of the rheologic properties of blood. The beneficial effects of insulin on platelet aggregation and blood viscosity are not evident in Type 2 diabetic patients, especially those with vascular complications and this may be relevant to the development of those complications.

[Blood flow assessment with Doppler color ultrasonography in primary and secondary tumors of the liver]

Our study was aimed at measuring hemodynamic changes in liver perfusion in patients with HCC and hepatic metastases using color Doppler US, a noninvasive investigation technique. Eighty-seven patients were examined: 14 of them had HCC and 34 had metastases; the control group consisted of 39 people. Blood flow was measured in the common hepatic artery and portal vein and the ratio of hepatic arterial to total liver blood flow (HPI = hepatic perfusion index) and the ratio of hepatic arterial to portal venous blood flow (A/V ratio) were calculated. HPI and A/V values were changed in HCC patients (HPI = 0.23, range: 0.16-0.35; A/V = 0.32, range: 0.19-0.55) as a consequence of reduced portal venous blood flow (9.76 +/- 2.51 cm3/s) and of increased hepatic arterial flow (2.78 +/- 0.46 cm3/s). HPI and A/V values were significantly changed also in the patients with hepatic metastases (HPI = 0.24, range: 0.11-0.38; A/V = 0.34, range: 0.12-0.61) compared with the control group. These changes were correlated with increased hepatic arterial blood flow (3.16 +/- 1.35 cm3/s) and decreased portal venous blood flow (10.39 +/- 3.81 cm3/s). These results prove the role of color Doppler US in the study of primary liver cancer and metastases. Additional examinations are nevertheless necessary to assess the diagnostic value of color Doppler US in the early detection of and discrimination between benign and malignant tumors.

Hyperbaric oxygen, oxygen-ozone therapy, and rheologic parameters of blood in patients with peripheral occlusive arterial disease

For many years, clinical practice has consolidated the use of both hyperbaric oxygen and oxygen-ozone therapy in the treatment of peripheral occlusive arterial disease (POAD). We investigated the influence of these treatments on hemorrheologic parameters that play an important role in the pathogenesis and the clinical course of arteriosclerosis. Two groups of 15 patients suffering from POAD, assigned at random either to a cycle of HBO therapy or O2-O3 therapy, were evaluated for blood viscosity, erythrocyte filterability, hematocrit value, fibrinogen concentration, and thrombin time. The O2-O3 therapy caused a significant increase of erythrocyte filterability and a significant decrease of blood viscosity. By contrast, HBO therapy did not produce any significant change. The increase of lipid peri-oxidation, proved by raised malonyldialdehyde plasma levels, seems a likely mechanism involved in the hemorrheologic effects of O2-O3 therapy.

Hemorheological and cardiovascular responses to beta-endorphin and naloxone in healthy subjects and in patients with essential hypertension

The purpose of the present study was to determine if opioid agonism (beta-endorphin) and antagonism (Naloxone) exert rheological and cardiovascular effects in normal humans and in patients with essential hypertension. Eight hypertensive patients were matched for age, sex, and body habitus (body mass index, waist to hip ratio) with eight normotensive healthy subjects. In all subjects, heart rate and blood pressure (continuous automatic recording), blood and plasma viscosity, fibrinogen, hematocrit, and platelet aggregation to ADP were evaluated during an infusion of human synthetic beta-endorphin (0.5 mg/h). On a different day and in randomized order, the subjects were submitted to another beta-endorphin infusion preceded by an i.v. naloxone bolus (5 mg in 5 min). beta-Endorphin and naloxone failed to significantly alter heart rate or blood pressure in both normotensive and hypertensive subjects. In hypertensive patients, beta-endorphin significantly increased blood viscosity and ADP-induced platelet aggregation, but only the former effect was naloxone-sensitive. In normotensive subjects, beta-endorphin caused a transient but significant decrease of platelet aggregation that was reversed by naloxone. These data suggest that beta-endorphin may play some role in the inhibitory control of platelet aggregation in normal subjects. An altered responsiveness of some rheological determinants to beta-endorphin seems to be present in human hypertension.

Air pollution by gasoline exhaust fumes: effect on platelet function and blood viscosity

Air pollution induced by automobile exhaust fumes seems to be involved in increased cardiovascular and respiratory morbidity. The effects of inhalation of such pollutant gases on platelet function and blood viscosity have not been sufficiently investigated, even if these parameters seem to be in strict correlation with cardiovascular function. Twelve healthy non-smoking volunteers were exposed for 30 minutes in a closed room to air polluted by automobile fumes. Platelet aggregation, blood viscosity, HbCO levels and P50 STD were determined before and after exposure. Cardiovascular parameters (blood pressure, heart rate and ECG) were also measured. At the end of the test, HbCO levels were significantly increased, but P50 STD was significantly reduced; an impairment of both platelet function and blood viscosity was observed. No significant changes in cardiovascular parameters were recorded. The decreases in platelet aggregation and blood viscosity were not directly correlated with either the increase in carbon monoxide levels or with the reduced P50 STD levels. It can be reasonably concluded that gasoline exhaust fumes could have been responsible for the observed alterations.