An overview of Personalized Medicine landscape and policies in the European Union

BACKGROUND

The spread of Personalized Medicine (PM) over the last decade defined a revolution in healthcare systems. PM is among the priorities of the European Commission's research agenda, which funded the IC2PerMed international project aiming to integrate China into the International Consortium of PM (ICPerMed). In the context of this project, we mapped the existing policies related to PM in the European Union (EU) and at the EU Member States (EU-MS) level.

METHODS

PubMed, Google Scholar, Google, Microsoft and national and international institutions' official repositories were searched in order to identify documents on PM-related policies, programmes and action plans at the EU and EU-MS level, published up to December 2020.

RESULTS

We identified 28 policies in the EU aimed at improving public health promoting and fostering PM implementation, through some actions including the standardization of good medical practice, use of big data and digital innovation, data sharing and cross-border interoperability, healthcare sustainability, disease prevention and patients'/citizens' engagement. We identified 23 policies at EU-MS level which, notwithstanding national differences, have a common focus, such as patient-tailored treatment and targeted prevention, education of healthcare workers, research and innovation, big data harmonization and healthcare system sustainability.

CONCLUSIONS

The definition of an integrated regulatory framework is essential to turn PM into an opportunity for citizens and patients with the involvement of all the stakeholders. This work can provide a valuable tool for decision-makers to define common approaches, priorities for research, development and increase international collaboration, which could overcome the fragmented European scenario and align the future direction on PM.

National taxation on sugar-sweetened beverages: a scoping review and time series analysis

Background

The intake of Sugar-Sweetened Beverages (SSBs) has increased around the world, leading to a growing burden of disease due to these beverages, such as obesity, diabetes, and heart disease. Taxation is a major action for comprehensive programmes aimed at reducing consumption of sugars. For these reasons, the aims of our study were to systematically summarize national tax legislation on SSBs and to assess the impact of these laws on the prevalence of overweight, obesity, and diabetes.

Methods

We conducted a scoping review to summarize the landscape of national tax laws on SSBs implemented worldwide. We included any document reporting both currently into force and past national tax laws addressing SSBs. As to the time series analysis, data regarding the national prevalence of obesity, overweight, and diabetes were retrieved from WHO Global Health Observatory data repository.

Results

As of July 2020, 34 countries worldwide implemented SSB taxation (amount-specific and ad valorem tax design), of which 17 (50.0%) in high-income countries, 12 (35.3%) in upper-middle income countries, and 5 (14.7%) in low-income countries. As for overweight, Hungary was the only country showing a slower rate of change after the taxation. Regarding obesity, France, Guatemala, Hungary and Panama showed a deceleration of the rates of change after the intervention. Eventually, Hungary and Tonga exhibited a one-time decrease of diabetes prevalence at the intervention point. Decelerating rates of change in the post-intervention period was also found for Guatemala and Fiji.

Conclusions

Laws targeting SSBs showed, at least in part, to be an effective measure to reduce the prevalence of overweight, obesity, and diabetes. Less than one fifth of worldwide countries have implemented national taxation policies. Finally, while taxation might be effective to reduce SSB consumption, other types of Public Health interventions, such as educational initiatives, should not be neglected.

Key messages

• Sugar-Sweetened Beverages (SSBs) are associated with obesity, diabetes, and heart disease. Taxation can be an important tool to reduce the consumption of SSBs.

• Prevalence of obesity, overweight and diabetes decreased in countries that adopted taxation. However, other strategies such as educational programs should be implemented to reduce the intake of SSBs.

CO2 production in waste management during the COVID pandemic in an Italian hospital

Background

Personal protection equipment (PPE) use in hospitals has consistently increased due to the Sars-Cov-2 outbreak, in wards repurposed for Covid-19 patients and wards that kept their usual activity. This increase influenced an environmental emergency in terms of health waste (HW) disposal. This study aims to assess the economic and environmental impact of the increase in HW generated before and during the pandemic in an Italian Hospital.

Methods

Data from 2016 to 2019 and 2020 to 2021 was retrieved from Risk Management department. Per capita and per days-of-stay waste quantity were calculated for the hospital inpatient wards and medical service areas (anatomical pathology, laboratories, radiology, nuclear medicine). Linear regression models assessed the epidemiological impact of COVID, and LOESS analysis modeled the relationship between infectious HW generation and the percentage of COVID-related inpatient days. Average weight of HW per patient was used to estimate the monetary value of CO2 produced.

Results

Preliminary results show that the inpatient days related to COVID nonlinearly influenced the infectious HW generated by wards. PPE usage increased in every context, and the proportion of COVID-related bed-days ranged from 2% to 12% in low-incidence months to 17% to 31% during acute phases. Pre-COVID CO2 production weighted 487 kg per patient and cost 1705€ per-capita, whereas during the pandemic it amounted to 768 kg per patient and cost 2688€ per capita which resulted in a significant increase of 983€ per patient.

Conclusions

In light of the results, HW disposal is an urgent issue that should be addressed by policy makers when implementing new monitoring systems for hospitals. A more adequate disposal of HW could substantially contribute in reducing air pollution and concurrently reduce the economic impact health systems due to the coronavirus pandemic.

Key messages

Walk the path of cervical cancer elimination in Italy: current scenario and shared recommendations

Issue/problem

In 2020, the World Health Organization (WHO) called for the elimination of cervical cancer. In order to get it, vaccination against Human Papillomavirus (HPV), screening of cervical cancer and treatment of high-grade cervical disease and cancer must be implemented at country level.

Description of the problem

Italy has implemented HPV vaccination and cervical cancer screening for many years. Nevertheless, nationwide data show that both vaccination coverage and adherence to screening programs are unsatisfactory as compared to the WHO 90 and 70 targets, namely 90% of girls fully vaccinated by the age of 15 years and 70% of women screened with a high-performance test (i.e., HPV-DNA test) by age 35 and again by 45.

Results

In order to address the progress of vaccination and screening at regional level in Italy, a project was conducted in 2021-2022 in order to collect data on relevant indicators and issues. In particular, information was collected on both coverage indicators (for both vaccination and screening) adherence (for screening) and history and characteristics of the vaccination offer (e.g., targets, gratuity) and of screening (e.g., presence of clinical pathways, type of tests used). Collected data were shared with a multidisciplinary panel of experts on HPV-related diseases to issue recommendations to foster the elimination of cervical cancer in Italy. For this purpose, a survey was also conducted to identify potential actions in respect to vaccination, screening and treatment.

Lessons

A great heterogeneity across Italian regions was observed. The following actions were identified to implement vaccination, screening and treatment: educational campaigns, reminders and active calls for both vaccination and screening and more interoperability of data and definition of clinical pathway involving a multidisciplinary medical team for the proper management of all HPV-related diseases.

Key messages

• Actions are requested at national level to achieve the goals set by the global strategy for cervical cancer elimination with respect to vaccination, screening and treatment.

• Actions identified to foster cervical cancer elimination in Italy includes educational campaigns, reminders and active calls, better interoperability of data and integrated medical team.

Planetary health research: insights from The Lancet Planetary Health original articles

Background

In 2017, the Lancet group launched The Lancet Planetary Health to promote the dissemination of research conducted in this field. Planetary health was also extensively discussed during the World Congress on Public Health 2020, which underlines the strategic importance recognized to this topic by experts and researchers active in public health at an international level. The aim was to investigate the role of public health university departments in the field of planetary health.

Methods

The Lancet Planetary Health database was queried from the inception to February 2021, to retrieve original articles or reviews whose first and/or last author was affiliated to a University Department of Public Health worldwide. We used the twenty-six EUPHA operational sections to define the research areas of the identified articles. The following data were extracted: study design, EUPHA area, research question, topic, identified gaps in the literature, and key concepts.

Results

Out of 543 entries, 44 original articles and reviews were included. Thirty-two percent studies were conducted in Asia, 20% in America, 13% in Europe, 8% in Oceania, 4% in Africa while 23% in a multicentric global context. The area investigated was mainly environmental and health (68%) followed by infectious disease control (14%). Collaboration across different disciplines is highly present in the authorships. Regarding the study design, 30% of the included articles were cohort studies.

Conclusions

From 2017 till February 2021, the number of studies performed by public health researchers published on The Lancet Planetary Health is gradually increasing.

Since published articles take advantage of the typical research methods and topics of public health and environmental health research, public health university departments can contribute to planetary health science if they seek transdisciplinary collaboration and adopt a planetary health vision.

Public opinion on vaccines: the role of the scientific community in Italy

Background

After rising for years, vaccination rates in Italy fell until 2015 because of unfounded safety concerns, abetted by some government and court actions. Public education and a 2017 law on mandatory vaccination have boosted rates since then. So far only a few papers have examined the correlation between beliefs and attitudes towards vaccines and the level of trust in the scientific community regarding vaccinations in the general population.

Methods

Data were extracted from the Italian section of the last two editions of the European Social Survey (ESS), the first carried out between September and November 2017, the latter between December 2018 and March 2019. A descriptive analysis was conducted using survey data. In the two editions respectively 2,626 and 2,745 persons were interviewed. The main outcomes assessed was comparing the two surveys, so as to highlight the key changes in public opinion on vaccines.

Results

In the 2017 edition, 19% of the respondents believed in the harmfulness of vaccines, out of them 29% did not even have trust in the scientific community while those confident in the safety of vaccines were 50%. In the 2019 survey, the proportion of those who believed vaccines to be harmful fell to 15%, the undecided rose to 15%, those opposed to the idea that vaccines are harmful became 63%, not responding people were 8%. Correspondingly, trust in the scientific community about vaccines has increased from 57% in the first survey to 70% in the last one.

Conclusions

The scientific community and research bodies in the last years, in support of the Ministry of Health, have made a huge effort in the public debate on vaccines. This might play a role in increasing the public confidence in the safety of vaccines and the adherence to vaccination campaigns, changing the climate with regard to vaccination in general.

Key messages

Italians changed their opinions on vaccines between two ESS surveys. The scientific community had a relevant role in the public debate on vaccines.

Understanding the determinants of vaccine hesitancy among adolescents: a systematic review

Background

The WHO defines vaccine hesitancy (VH) as ‘a delay in acceptance or refusal of vaccines despite the availability of vaccine services'. In spite of the models explaining VH and the tools used to address it, VH still represents a current problem and has been declared one of the top ten global health threats by WHO in 2019. This is mainly true for the adolescents who represents 25% of the global population. This systematic review aims to address the determinants of VH in this target population.

Methods

PubMed, Web of Science and Scopus were searched to retrieve articles, published in English, assessing adolescents' attitudes and confidence towards vaccinations with any study design (qualitative or quantitative) from the inception until Dec 2020. A methodological quality assessment of the articles was performed based on the study designs.

Results

Out of 14,704 articles, 20 studies were included in the qualitative analysis. Ten out of 20 studies were evaluated as of “good quality”, while nine had “moderate quality” and only one had “poor quality”. Factors associated to a positive attitude towards vaccination included knowledge of vaccine preventable diseases, the awareness of vaccines, their efficacy, safety and free of charge, higher education level and active involvement in decision-making. An association between VH and socio-economic conditions was also highlighted.

Conclusions

This systematic review elucidated a better understanding of the determinants of VH among the adolescent population. Adolescence represents a crucial phase of life in which boys and girls begin to make significant choices about their health and develop attitudes and behaviours that continue into adulthood. Indeed, their concerns and needs in respect to vaccination should be widely examined and taken into consideration to plan tailored interventions to promote vaccination and reduce VH.

Key messages

Vaccine hesitancy among adolescents is a major global health priority. This problem is little studied and further studies and initiatives aimed at increasing awareness of the problem should be deserved.

Combining personalised medicine and patient-centered care in breast cancer: a systematic review

Background

Breast Cancer (BC) is estimated to cause 2.3 million yearly new cases worldwide. Efforts towards standardized, quality assured and effective care have led to an increasing complexity and specialization of BC management. This systematic review's aim is to describe the state-of-the art of available literature investigating the enactment of personalised medicine and patient-centered care models in BC practice and build a framework towards personalised BC care within a patient-centered model.

Methods

Databases were searched to retrieve articles reporting on BC management, evaluated in terms of patient-centered and personalised medicine approaches, assessing success factors or limits, in English, from the inception to December 2020. The investigated dimensions for patient-centered care models were audits, communication, informative systems and multidisciplinarity. Concerning Personalised Medicine, investigations were related to molecular boards, genetic testing and shared-clinical decision-making.

Results

Out of 1885 records, 25 studies were included in the qualitative analysis. The main success factors are multi-professional collaborations with defined roles and responsibilities, training programs on genomic tools and adequate communication strategy (i.e universal genomic language) to involve patients in the decision-making process. Among detected barriers, delays in genetic testing use were linked to the lack of public reimbursement and of clarity in timing and appropriateness.

Conclusions

Both these models are complementary and needed to ensure effective changes in the path of BC patient management. Our framework aims to the transformation of standardized application of evidence-based medicine into a dynamic and personalised care pathway.

Key messages

The combination of the two care delivery approaches is scarcely investigated in literature. Our framework would allow to fill such gap and attributes a key role to sharing the decision-making process.

The prognostic role of micro-RNAs in Head and Neck Cancers: an umbrella review

Head and neck cancer (HNC) represents the sixth most common cancer and the seventh cause of cancer-related deaths worldwide. Because of HNC high mortality and morbidity a support from the development of new biomarkers and personalized care for patients is needed. The role of micro-RNAs (miRs), as new epigenetic biomarkers, aimed at improving early diagnosis, predicting prognosis and establishing effective cancer therapies, has recently received considerable attention. The aim of this study was to conduct an umbrella review that synthetizes all the findings of systematic reviews already available in literature that investigate the prognostic role of miRs as potential biomarkers in the field of tertiary prevention of HNC.

We selected systematic reviews, published in English until December 2019, related to human HNC with meta-analysis of observational studies that reported quantitative prognostic measures, Hazard Ratios (HRs), of Overall Survival (OS) or Disease-Free Survival (DFS). The methodological quality of the included reviews was assessed using the Assessment of Multiple Systematic Reviews AMSTAR 2 tool.

Six systematic reviews were included in the umbrella review. The most reported miRNAs were: miR21; the Let7 family (c,d,g), miR17, 18 family, 20a, 29 family, 125b, 375. A total of 4 reviews assessed miR-21 expression in HNC patients, all showing its upregulation.

The most frequently studied miR was miR21 which was reported either in the OS and DFS statistical analyses. The OS analysis showed a significant lower prognosis when miR21 was upregulated.

It is involved in oncogenic and oncosuppressive cell signals pathways: the overexpression of miR21 was shown to be associated with cell proliferation, migration, invasion and survival. Recently the cumulative effects of sets of miRs has been increasingly studied and they might be stronger predictor of survival than single. The role of miRNAs as a prognostic biomarker specifically in HNC still need to be investigated.

Key messages

Some miRs were demonstrated to have as tumor-suppressing and oncogenic roles according to their level of regulation (up/down-regulation) in Head and Neck cancer patients. The role of miRs as prognostic biomarkers in HNC patients still need to be addressed by performing large scale to verify and enhance the power of evidence and clinical utility of these.

Spatiotemporal distribution of a non-haematophagous bat community and rabies virus circulation: a proposal for urban rabies surveillance in Brazil

In Brazil, rabies surveillance is based on monitoring domestic and wild animals, although the most prevalent lineage of the rabies virus (RABV) currently diagnosed in Brazil is associated with bats, particularly non-haematophagous bats. Disease control is based on the mass vaccination of dogs and cats. We used data collected by the passive surveillance system of the city of Campinas from 2011 to 2015, to describe the temporal and geographic distributions of the bat specimens and RABV and discuss the current rabies surveillance with the advent of the declaration of canine and feline rabies-free areas in Brazil. We described the species, locations and health statuses of the collected bat specimens. Moreover, all samples were submitted for RABV diagnosis. Then, we performed a time series decomposition for each bat family. Additionally, we determined the spatiotemporal relative risk for RABV infection using the ratio of the kernel-smoothed estimates of spatiotemporal densities of RABV-positive and RABV-negative bats. From the 2537 bat specimens, the most numerous family was Molossidae (72%), followed by Vespertilionidae (14%) and Phyllostomidae (13%). The bat families behaved differently in terms of seasonal and spatial patterns. The distribution of bats varied geographically in the urban environment, with Molossidae and Phyllostomidae being observed downtown and Vespertilionidae being observed in peripheral zones. Concurrently, a significant relative risk of RABV infection was observed downtown for Vespertilionidae and in peripheral zones for Molossidae. No RABV-positive sample clusters were observed. As a result of the official declaration of RABV-free areas in southern Brazil, mass dog and cat vaccinations are expected to halt in the near future. This stoppage would make most dog and cat populations susceptible to other RABV lineages, such as those maintained by non-haematophagous bats. In this scenario, all information available on bats and RABV distribution in urban areas is essential. Currently, few studies have been conducted. Some local health authorities, such as that in Campinas, are spontaneously basing their surveillance efforts on bat rabies, which is the alternative in reality scenario of increased susceptibility to bat-associated RABV that is developing in Brazil.

Aerobic fitness and performance in elite female futsal players

Despite its growing popularity, few studies have investigated specific physiological demands for elite female futsal. The aim of this study was to determine aerobic fitness in elite female futsal players using laboratory and field testing. Fourteen female futsal players from the Venezuelan National team (age =21.2±4.0 years; body mass =58.6±5.6 kg; height =161±5.0 cm) performed a progressive maximal treadmill test under laboratory conditions. Players also performed a progressive intermittent futsal-specific field test for endurance, the Futsal Intermittent Endurance Test (FIET), until volitional fatigue. Outcome variables were exercise heart rate (HR), VO₂, post-exercise blood lactate concentrations ([La]b) and running speeds (km · h^-1). During the treadmill test, VO₂max, maximal aerobic speed (MAS), HR and peak [La]b were 45.3±5.6 ml · kg^-1 · min^-1, 12.5±1.77 km · h^-1, 197±8 beats · min^-1 and 11.3±1.4 mmol · l^-1, respectively. The FIET total distance, peak running velocity, peak HR and [La]b were 1125.0±121.0 m, 15.2±0.5 km · h^-1, 199±8 beats · min^-1 and 12.5±2.2 mmol · l^-1, respectively. The FIET distance and peak speed were strongly associated (r= 0.85-87, p < 0.0001) with VO₂max and MAS, respectively. Peak HR and [La]b were not significantly different between tests. Elite female futsal players possess moderate aerobic fitness. Furthermore, the FIET can be considered as a valid field test to determine aerobic fitness in elite level female futsal players.

Anthropometric and physiological characteristics of Melanesian futsal players: a first approach to talent identification in Oceania

This study assessed the anthropometric and physiological characteristics of elite Melanesian futsal players in order to determine the best performance predictors. Physiological parameters of performance were measured in 14 Melanesian (MEL-G, 24.4±4.4 yrs) and 8 Caucasian (NMEL-G, 22.9±4.9) elite futsal players, using tests of jump-and-reach (CMJ), agility (T-Test), repeated sprint ability (RSA), RSA with change-of-direction (RSA-COD), sprints with 5 m, 10 m, 15 m, and 30 m lap times, and aerobic fitness with the 30-15 intermittent fitness test (30-15 IFT). The anthropometric data revealed significantly lower height for MEL-G compared with NMEL-G: 1.73±0.05 and 1.80±0.08 m, respectively; P = 0.05. The CMJ was significantly higher for MEL-G than NMEL-G: 50.4±5.9 and 45.2±4.3 cm, respectively; P = 0.05. T-Test times were significantly lower for MEL-G than NMEL-G: 10.47±0.58 and 11.01±0.64 seconds, respectively; P = 0.05. MEL-G height was significantly related to CMJ (r = 0.706, P = 0.01), CMJ_peakP (r = 0.709, P = 0.01) and T-Test (r = 0.589, P = 0.02). No significant between-group differences were observed for sprint tests or 30-15 IFT, including heart rate and estimated VO_2max. Between groups, the percentage decrement (%Dec) in RSA-COD was significantly lower in MEL-G than NMEL-G (P = 0.05), although no significant difference was noted between RSA and RSA-COD. Within groups, no significant difference was observed between %Dec in RSA or RSA-COD; P = 0.697. This study presents specific anthropometric (significantly lower height) and physiological (significantly greater agility) reference values in Melanesians, which, taken together, might help coaches and physical fitness trainers to optimize elite futsal training and talent identification in Oceania.

Effect of the number of sprint repetitions on the variation of blood lactate concentration in repeated sprint sessions

The aim of the present study was to examine the effect of number of sprint repetitions on the variation of blood lactate concentration (blood [La]) during different repeated-sprint sessions in order to find the appropriate number of sprint repetitions that properly simulates the physiological demands of team sport competitions. Twenty male team-sport players (age, 22.2 ± 2.9 years) performed several repeated-sprint sessions (RSS) consisting of 1, 2, 3, 4, 5, 9, or 10 repetitions of 30 m shuttle sprints (2 × 15 m) with 30 s recovery in between. The blood [La] was obtained after 3 min of recovery at the end of each RSS. The present study showed that for RSS of 3 sprints (RSS3) there was a high increase (p<0.001) in blood [La], which reached approximately fivefold resting values (9.4±1.7 mmol · l⁻¹) and then remained unchanged for the RSS of 4 and 5 sprints (9.6±1.4 and 10.5±1.9 mmol · l⁻¹, p=0.96 and 0.26, respectively). After RSS9 and RSS10 blood [La] further significantly increased to 12.6 and 12.7 mmol · l⁻¹, p<0.001, respectively. No significant difference was found between RSS3, RSS4 and RSS5 for the percentage of sprint speed decrement (Sdec) (1.5±1.2; 2.0±1.1 and 2.6±1.4%, respectively). There was also no significant difference between RSS9 and RSS10 for Sdec (3.9±1.3% and 4.5±1.4%, respectively). In conclusion, the repeated-sprint protocol composed of 5 shuttle sprint repetitions is more representative of the blood lactate demands of the team sports game intensity.

Sprint vs. interval training in football

The aim of this study was to compare the effects of high-intensity aerobic interval and repeated-sprint ability (RSA) training on aerobic and anaerobic physiological variables in male football players. Forty-two participants were randomly assigned to either the interval training group (ITG, 4 x 4 min running at 90 - 95 % of HRmax; n = 21) or repeated-sprint training group (RSG, 3 x 6 maximal shuttle sprints of 40 m; n = 21). The following outcomes were measured at baseline and after 7 weeks of training: maximum oxygen uptake, respiratory compensation point, football-specific endurance (Yo-Yo Intermittent Recovery Test, YYIRT), 10-m sprint time, jump height and power, and RSA. Significant group x time interaction was found for YYIRT (p = 0.003) with RSG showing greater improvement (from 1917 +/- 439 to 2455 +/- 488 m) than ITG (from 1846 +/- 329 to 2077 +/- 300 m). Similarly, a significant interaction was found in RSA mean time (p = 0.006) with only the RSG group showing an improvement after training (from 7.53 +/- 0.21 to 7.37 +/- 0.17 s). No other group x time interactions were found. Significant pre-post changes were found for absolute and relative maximum oxygen uptake and respiratory compensation point (p < 0.05). These findings suggest that the RSA training protocol used in this study can be an effective training strategy for inducing aerobic and football-specific training adaptations.

Variation in Top Level Soccer Match Performance

This study examined the influence of the opposing team, seasonal variations and the influence of first half activity on match performance in top-level soccer players. Physical performance measures were collected using the ProZone match analysis system from 20 professional soccer players from the same team and their opponents (n = 188) during a season. Match activities (standing, walking, jogging, running, high-speed running and sprinting), distances (total distance [TD], high-intensity running [HIR] and very high-intensity running [VHIR]) and other measures including involvement with the ball and peak running speed were collected. The influence of opponent team, the level of opposition, first half physical activities on second half activities, and playing position were analysed. The main finding was that TD (r = 0.62, p < 0.05), HIR (r = 0.51, p < 0.05), and VHIR (r = 0.65, p < 0.05) of the reference team was influenced by the activity profile of the opponent teams. The TD and HIR was higher against Best opponent teams compared to Worst opponent teams (p < 0.05), and the TD, HIR and VHIR travelled in the first half significantly influenced the distances covered in the second half. TD, HIR and VHIR were greater at the end of the season. These results may be used to interpret meaningful changes in match performance in top level soccer.

Effect of plyometric training on sand versus grass on muscle soreness and jumping and sprinting ability in soccer players

OBJECTIVE

The lower impact on the musculoskeletal system induced by plyometric exercise on sand compared to a firm surface might be useful to reduce the stress of intensified training periods or during rehabilitation from injury. The aim of this study was to compare the effects of plyometric training on sand versus a grass surface on muscle soreness, vertical jump height and sprinting ability.

DESIGN

Parallel two-group, randomised, longitudinal (pretest-post-test) study.

METHODS

After random allocation, 18 soccer players completed 4 weeks of plyometric training on grass (grass group) and 19 players on sand (sand group). Before and after plyometric training, 10 m and 20 m sprint time, squat jump (SJ), countermovement jump (CMJ), and eccentric utilization ratio (CMJ/SJ) were determined. Muscle soreness was measured using a Likert scale.

RESULTS

No training surface x time interactions were found for sprint time (p>0.87), whereas a trend was found for SJ (p = 0.08), with both groups showing similar improvements (p<0.001). On the other hand, the grass group improved their CMJ (p = 0.033) and CMJ/SJ (p = 0.005) significantly (p<0.001) more than players in the sand group. In contrast, players in the sand group experienced less muscle soreness than those in the grass group (p<0.001).

CONCLUSIONS

Plyometric training on sand improved both jumping and sprinting ability and induced less muscle soreness. A grass surface seems to be superior in enhancing CMJ performance while the sand surface showed a greater improvement in SJ. Therefore, plyometric training on different surfaces may be associated with different training-induced effects on some neuromuscular factors related to the efficiency of the stretch-shortening cycle.

Physiological and performance effects of generic versus specific aerobic training in soccer players

The aim of this study was to compare the effects of specific (small-sided games) vs. generic (running) aerobic interval training on physical fitness and objective measures of match performance in soccer. Forty junior players were randomly assigned to either generic (n=20) or specific (n=20) interval training consisting of 4 bouts of 4 min at 90-95 % of maximum heart rate with 3 min active rest periods, completed twice a week. The following outcomes were measured at baseline (Pre), after 4 weeks of pre-season training (Mid), and after a further 8 weeks of training during the regular season (Post): maximum oxygen uptake, lactate threshold (Tlac), running economy at Tlac, a soccer-specific endurance test (Ekblom's circuit), and indices of physical performance during soccer matches (total distance and time spent standing, walking, and at low- and high-intensity running speed). Training load, as quantified by heart rate and rating of perceived exertion, was recorded during all training sessions and was similar between groups. There were significant improvements in aerobic fitness and match performance in both groups of soccer players, especially in response to the first 4 weeks of pre-season training. However, no significant differences between specific and generic aerobic interval training were found in any of the measured variables including soccer specific tests. The results of this study showed that both small-sided games and running are equally effective modes of aerobic interval training in junior soccer players.

The effect of match standard and referee experience on the objective and subjective match workload of English Premier League referees

The aim of the present study was to examine the effect of match standard and referee experience on the objective and subjective workload of referees during English Premier League and Football League soccer matches. We also examined the relationship between heart rate (HR) and ratings of perceived exertion (RPE) for assessing match intensity in soccer referees. Heart rate responses were recorded using short-range telemetry and RPE scores were collected using a 10-point scale. Analysis revealed a significant relationship between mean match HR and match RPE scores (r=0.485, p<0.05, n=18). There were significant differences in match HR (Premier League 83.6+/-2.6% maximal HR (HRmax) versus Football League 81.5+/-2.2%HRmax, p<0.05) and match RPE scores (Premier League 7.8+/-0.8 versus Football League 6.9+/-0.8, p<0.05) between standards of competition. Referee experience had no effect on match HR and RPE responses to Premier League and Football League matches. The results of the present study demonstrate the validity of using HR and RPE as a measure of global match intensity in soccer referees. Referee experience had no effect on the referees' objective and subjective match workload assessments, whereas match intensity was correlated to competition standard. These findings have implications for fitness preparation and evaluation in soccer referees. When progressing to a higher level of competition, referees should ensure that appropriate levels of fitness are developed in order to enable them to cope with an increase in physical match demands.

Strong correlation of maximal squat strength with sprint performance and vertical jump height in elite soccer players

BACKGROUND

A high level of strength is inherent in elite soccer play, but the relation between maximal strength and sprint and jumping performance has not been studied thoroughly.

OBJECTIVE

To determine whether maximal strength correlates with sprint and vertical jump height in elite male soccer players.

METHODS

Seventeen international male soccer players (mean (SD) age 25.8 (2.9) years, height 177.3 (4.1) cm, weight 76.5 (7.6) kg, and maximal oxygen uptake 65.7 (4.3) ml/kg/min) were tested for maximal strength in half squats and sprinting ability (0-30 m and 10 m shuttle run sprint) and vertical jumping height.

RESULT

There was a strong correlation between maximal strength in half squats and sprint performance and jumping height.

CONCLUSIONS

Maximal strength in half squats determines sprint performance and jumping height in high level soccer players. High squat strength did not imply reduced maximal oxygen consumption. Elite soccer players should focus on maximal strength training, with emphasis on maximal mobilisation of concentric movements, which may improve their sprinting and jumping performance.

Prenatal Diagnosis after ART Success: The Role of Early Combined Screening Tests in Counselling Pregnant Patients

First-trimester Down syndrome screening may cause a higher false positive rate in pregnant patients who have undergone ART (assisted reproductive technologies). The aim of this paper is to contribute to this analysis with the second largest series of combined biophysical and biochemical tests in the first trimester of pregnancy after ART. One hundred and forty-two singleton successful ART pregnancies were selected for this study: 50 pregnancies induced by using in-vitro fertilization (IVF), and 92 using intracytoplasmic sperm injection (ICSI). Each patient was matched with three naturally conceived pregnancies based on maternal age and gestational age. Free beta-HCG and PAPP-A were measured on dried blood spots and converted to MoMs. Nuchal translucency (NT) was measured by certified operators. Mean maternal age was 33 +/- 4. NT, free beta-HCG and PAPP-A values of the control cases were not significantly different from local standards evaluated on 3043 cases. NT between ART pregnancies and matched controls was not significantly different. PAPP-A was reduced but not significantly lower in ART pregnancies. Free beta-HCG was the only analyte that resulted in significantly higher values in ART pregnancies (1.12 MoM) versus controls (0.99 MoM). No significant differences were found for biochemical values observed between ICSI and IVF patients. The screen positive rates observed in ART and control pregnancies were 5.5 per cent and 4.6 per cent respectively. NT measurements were not affected by ART pregnancies. Our results (non-significant lower values of PAPP-A and significantly higher free beta-HCG values) were consistent with other reported series. The increase in the screen positive rate determined by these biological variations was not greater than 0.9 per cent. This higher false positive rate has a negligible impact on counselling ART patients. The algorithm used to calculate the relative risk after the combined tests should not be changed until the detection rate of trisomies in ART pregnancies is not fully disclosed by larger series.

Steroid-induced plasticity in the sexually dimorphic vasotocinergic innervation of the avian brain: behavioral implications

Vasotocin (VT, the antidiuretic hormone of birds) is synthesized by diencephalic magnocellular neurons projecting to the neurohypophysis. In addition, in male quail and in other oscine and non-oscine birds, a sexually dimorphic group of VT-immunoreactive (ir) parvocellular neurons is located in a region homologous to the mammalian nucleus of the stria terminalis, pars medialis (BSTm) and in the medial preoptic nucleus (POM). These cells are not visible in females. VT-ir fibers are present in many diencephalic and extradiencephalic locations. Quantitative morphometric analyses demonstrate that, in quail, these elements are expressed in a sexually dimorphic manner (males>females) in regions involved in the control of different aspects of reproduction: i.e., the POM (copulatory behavior), the lateral septum (secretion of gonadotropin-releasing hormone [GnRH]), the nucleus intercollicularis (control of vocalizations), and the locus coeruleus (the main noradrenergic center of the avian brain). In many of these regions, VT-ir fibers are closely related to aromatase-ir, GnRH-ir, or estrogen receptor-expressing neurons. This dimorphism has an organizational nature: administration of estradiol-benzoate to quail embryos (a treatment that abolishes male sexual behavior) results in a dramatic decrease of the VT-immunoreactivity in all sexually dimorphic regions of the male quail brain. Conversely, the inhibition of estradiol (E2) synthesis during embryonic life (a treatment that stimulates the expression of male copulatory behavior in adult testosterone (T)-treated females) results in a male-like distribution of VT-ir cells and fibers. Castration markedly decreases the immunoreactivity in both the VT-immunopositive elements of the BSTm and the innervation of the SL and POM, whereas T-replacement therapy restores the VT immunoreactivity to a level typical of intact birds. These changes reflect modifications of VT mRNA concentrations (and probably synthesis) as demonstrated by in situ hybridization and they are paralleled by similar changes in male copulatory behavior (absent in castrated male quail, fully expressed in CX+T males). The aromatization of T into estradiol (E2) also controls VT expression and, in parallel limits the activation of male sexual behavior by T. In castrated male quail, the restoration by T of the VT immunoreactivity in POM, BSTm and lateral septum could be fully mimicked by a treatment with E2, but the androgen 5alpha-dihydrotestosterone (DHT) had absolutely no effect on the VT immunoreactivity in these conditions. At the doses used in this study, DHT also did not synergize with E2 to enhance the density of VT immunoreactive structures. Systemic or i.c.v. injections of VT markedly inhibit the expression of all aspects of male sexual behavior. VT, presumably, does not simply represent one step in the biochemical cascade of events that is induced by T in the brain and leads to the expression of male sexual behavior. Androgens and estrogens presumably affect reproductive behavior both directly, by acting on steroid-sensitive neurons in the preoptic area, and indirectly, by modulating peptidergic (specifically vasotocinergic) inputs to this and other areas. The respective contribution of these two types of actions and their interaction deserves further analysis.

Effect of maximal aerobic power on match performance in elite soccer referees

The aim of this study was to verify whether referees' maximal aerobic power could influence competitive match exercise intensity. Eight elite-level referees (mean +/- SD age, 37.6 +/- 3.4 years) were each observed during 2 Serie A matches (n = 16), and the mean of each match activity was used for analysis. Match activities were monitored with encoder-equipped cameras. .V(O)(2)max was assessed under field conditions with a portable device during a progressive multistage protocol. The .V(O)(2)max of each subject was expressed in absolute terms (.V(O)(2)max(ab), L.min(-1)), relative terms (.V(O)(2)max (rel), ml.kg(-1).min(-1)), and independent from body mass (.V(O)(2)max (ind), ml.kg(-0.75).min(-1)). Significance was set at p < or = 0.05 for all measurements. Total distance covered during the match correlated significantly with .V(O)(2)max (ind) (r = 0.77) and .V(O)(2)max (ab) (r = 0.87). .V(O)(2)max (ind), .V(O)(2)max (rel), and .V(O)(2)max (ab) correlated negatively (p < 0.05) with the time spent standing still during the match (r = -0.90, -0.85, and -0.86, respectively, p < 0.05). During the first half of the match, referees with higher levels of .V(O)(2)max (rel) (r = 0.93, p < 0.05) and .V(O)(2)max (ind) (r = 0.90, p < 0.05) were able to cover more distance at medium intensity. In the second half of the match, medium-intensity distance and low-intensity time correlated significantly (p < 0.05) with .V(O)(2)max (ab) (r = 0.76) and .V(O)(2)max (rel) (r = 0.75), respectively. The results demonstrate the positive influence of .V(O)(2)max in determining both the total amount of distance covered and the exercise intensity during a game. Higher levels of .V(O)(2)max may provide referees the opportunity to be more active and therefore closer to the action on the field during the game.

Analysis of match activities in elite soccer referees during actual match play

This study describes the work-rate profile of Italian high-level soccer referees (N = 33). The referees were examined during official games (n = 96) of the 1992-1996 first division Italian championships (Series A). Subjects were all experienced, top-level referees enrolled in the Commissione Arbitri Nazionali and officiated in the Series A and B Italian championships. Mean age of the referees studied was 37.8 +/- 2.1 years. Match analysis was performed using a technology similar to that reported by Ohashi et al. in 1988. Average match distance was 11,469 +/- 983 m. Referees, on average, covered 17.2% of the entire match distance at speeds faster than 18.1 km x h(-1). A 4.1% decrement of the total distance covered was evident during the second half (p < 0.001). Furthermore, less distances were covered running backward and sideways during the second half compared to the first half (p < 0.001). Nevertheless, the referees experienced no decrement in the distance covered at speeds faster than 18.1 km x h(-1) throughout the match. Match analysis revealed the intermittent nature of the referees' activities. Their intensity varied from situation to situation, frequently reaching near maximal intensity. However, sprint bouts never lasted for more than a few seconds (2-4 seconds). Therefore, refereeing, at least at top level, places unique stresses on the officials, and thus specific training and fitness assessment are needed.

Physiological load imposed on elite soccer referees during actual match play

BACKGROUND

The aim of this study as to describe the work-rate profile and cardiovascular stress of Italian high level soccer referees (n = 18). METHODS.

EXPERIMENTAL DESIGN

The referees were examined during official games of the 1992-1993 first division Italian championship (serie A).

PARTICIPANTS

subjects were all experienced top level referees enrolled in the CAN (Commissione Arbitri Nazionali) and thus officiating in the serie A e B Italian championships. Mean age of the referees considered here was 37.5 +/- 2.14 years.

MEASURES

heart rates were monitored by short-range radio telemetry. Match analysis was performed with methodologies similar to that reported by Ohashi et al. (1988).

RESULTS

Average match distance was 11376 +/- 1600 m (7818-13063) and no overall differences were observed between halves (p > 0.05). Nevertheless less distances were covered running backward and side-wards during the second half compared to the first half (p < 0.05). Referees, on average, covered 41.7% of the whole match distance at speeds faster than 13.1 km x h(-1). Heart rates attained 89.1% of the estimated maximal over the duration of a full game and no difference was observed between halves (p = 0.72). Mean heart rates of the first 15 min of play were lower than the other two sections of the first half (p < 0.05).

CONCLUSIONS

Match analysis revealed the intermittent nature of the referees' activities. Their intensity varied from situation to situation, frequently reaching near maximal intensity. However, sprint bouts never lasted for more than few seconds (2-4 sec). Top level soccer refereeing places high physiological demands on the official thus specific training and fitness assessment are needed.

Effects of testosterone on the synaptology of the medial preoptic nucleus of male Japanese quail

The medial preoptic nucleus (POM) of male Japanese quail is a sexually dimorphic testosterone-dependent structure that plays a key role in the activation of male sexual behavior. Both the total volume of the nucleus and the size of the dorsolateral neurons are decreased in gonadectomized males. Immunocytochemical studies have revealed a complex pattern of innervation: immunopositive fibers for several neuropeptides and neurotransmitters have been detected in the POM; some of them (e.g. vasotocin-immunoreactive fibers) are sexually dimorphic and testosterone-dependent To understand the anatomical bases of these testosterone-dependent neurochemical changes, we performed an ultrastructural study of the POM neuropil in intact sexually mature, gonadectomized, or testosterone-treated gonadectomized males. A complex synaptic organization of the POM neuropil was observed in intact male quail reflecting the heterogeneity of the neurotransmitters and neuropeptides present in this nucleus. Changes in this organization were observed after the endocrine manipulations. The number of axosomatic synapses per cell body decreased after gonadectomy and was restored to the level observed in the intact group after the administration of testosterone. By contrast, no significant change was observed in the density of axodendritic and axospinal synapses after hormonal manipulations which suggests that the total number of synapses in the nucleus should be affected by testosterone (constant density in a changing total volume). The cross-sectional area of synaptic boutons was also decreased by castration and restored to intact level by testosterone. The action of testosterone on the activation of male copulatory behavior in gonadectomized birds is hence paralleled by an extensive rearrangement of neuropil in the POM.

Sub-MIC ciprofloxacin effect on fimbrial production by uropathogenic Escherichia coli strains

The urine from 210 patients with acute urinary tract infection (UTI) was examined to study the in vitro effect of ciprofloxacin on fimbriae production by uropathogenic Escherichia coli isolates. Forty-nine bacterial samples of density 10(5) CFU/ml were not considered. From the resulting 161 samples, E. coli was the major strain found, present in 54 samples. Other microoganisms found were: Enterococcus sp. (34 samples), Staphylococcus epidermis (22), yeasts (11), Proteus sp. (11), Pseudomonas sp. (11), Klebsiella sp. (8), Enterobacter sp. (6), Citrobacter sp. (3), and Acinetobacter sp. (1). The uropathogenic E. coli strains found were P-fimbriated, as demonstrated by hemoagglutination activity against human erythrocytes with and without mannose, SDS-PAGE of fimbrial proteins and transmission electron microscopy (TEM). All E. coli strains found were exposed in vitro to sub-inhibitory concentrations of ciprofloxacin (1/8 MIC). Our results showed that: 1) P-fimbriated E. coli is the most prevalent microorganism in acute UTI (34%); 2) exposure to sub-MICs of ciprofloxacin inhibits fimbrial production in 79% of E. coli strains; 3) the pattern of SDS-PAGE fimbrial proteins is modified after exposure; in particular, the most affected synthesis involves the protein at 18 kD known as P-fimbriae.

Organizational effects of estrogens on brain vasotocin and sexual behavior in quail

Reproductive behavior is sexually differentiated in quail: The male-typical copulatory behavior is never observed in females even after treatment with high doses of testosterone (T). This sex difference in behavioral responsiveness to T is organized during the embryonic period by the exposure of female embryo to estrogens. We showed recently that the sexually dimorphic medial preoptic nucleus (POM), a structure that plays a key role in the activation of male copulatory behavior, is innervated by a dense steroid-sensitive network of vasotocin-immunoreactive (VT-ir) fibers in male quail This innervation is almost completely absent in the female POM and is not induced by a chronic treatment with T, suggesting that this neurochemical difference could be organizational in nature. This idea was tested by injecting fertilized quail eggs of both sexes on day 9 of incubation with either estradiol benzoate (EB) (25 microg, a treatment that suppresses the capacity to show copulatory behavior in adulthood) or the aromatase inhibitor R76713 (10 microg, a treatment that makes adult females behaviorally responsive to T), or with the solvents as a control (C). At 3 weeks posthatch, all subjects were gonadectomized and later implanted with Silastic capsules filled with T. Two weeks later, all birds were perfused and brain sections were processed for VT immunocytochemistry. Despite the similarity of the adult endocrine conditions of the subjects (all were gonadectomized and treated with T Silastic implants providing the same plasma level of steroid to all subjects), major qualitative differences were observed in the density of VT-ir structures in the POM of the different groups. Dense immunoreactive structures (fibers and a few cells) were observed in the POM of C males but not females; EB males had completely lost this immunoreactivity (and lost the capacity to display copulatory behavior); and, conversely, R76713 females displayed a male-typical VT-ir system in the nucleus (and also high levels of copulatory behavior). Similar changes in immunoreactivity were seen in the nucleus of the stria terminalis and in the lateral septum (VT-ir fibers only in this case) but not in the magnocellular vasotocinergic system. These neurochemical changes closely parallel the effects of the embryonic treatments on male copulatory behavior. The vasotocinergic system of the POM can therefore be considered an accurate marker of the sexual differentiation of brain circuits mediating this behavior.

Systemic and intracerebroventricular injections of vasotocin inhibit appetitive and consummatory components of male sexual behavior in Japanese quail

The authors investigated the behavioral actions of vasotocin (VT) in castrated testosterone-treated male Japanese quail. The appetitive and consummatory components of sexual behavior as well as the occurrence frequency of crows were inhibited, in a dose-dependent manner, by injections of VT. The authors observed opposite effects after injection of the V1 receptor antagonist, dPTyr(Me)AVP. Lower doses of VT were more active after central than after systemic injection, and effects of systemic injections of VT were blocked by a central injection of dPTyr(Me)AVP. The behavioral inhibition was associated with a modified diuresis after systemic but not central injection. These results provide direct evidence that VT affects male sexual behavior in quail by a direct action on the brain independent of its peripheral action on diuresis.

Systemic and intracerebroventricular injections of vasotocin inhibit appetitive and consummatory components of male sexual behavior in Japanese quail

The authors investigated the behavioral actions of vasotocin (VT) in castrated testosterone-treated male Japanese quail. The appetitive and consummatory components of sexual behavior as well as the occurrence frequency of crows were inhibited, in a dose-dependent manner, by injections of VT. The authors observed opposite effects after injection of the V1 receptor antagonist, dPTyr(Me)AVP. Lower doses of VT were more active after central than after systemic injection, and effects of systemic injections of VT were blocked by a central injection of dPTyr(Me)AVP. The behavioral inhibition was associated with a modified diuresis after systemic but not central injection. These results provide direct evidence that VT affects male sexual behavior in quail by a direct action on the brain independent of its peripheral action on diuresis.

Effects of dopamine agonists on appetitive and consummatory male sexual behavior in Japanese quail

The effects of pharmacological manipulations of dopaminergic transmission on appetitive and consummatory aspects of male sexual behavior were investigated in castrated male Japanese quail treated with exogenous testosterone. Appetitive male sexual behavior was assessed by measuring a learned social proximity response and consummatory behavior was assessed by measuring copulatory behavior per se. The nonselective dopamine receptor agonist, apomorphine, inhibited in a dose-dependent manner both components of male sexual behavior. Two indirect dopamine agonists were also tested. Nomifensine, a dopamine re-uptake inhibitor, decreased appetitive sexual behavior but increased the frequency of mount attempts, a measure of consummatory sexual behavior. Amfonelic acid, a compound that enhances dopaminergic tone by a complex mechanism, increased aspects of both appetitive and consummatory behaviors. These data suggest that, in quail, as in rodents, increases in dopaminergic tone facilitate both appetitive and consummatory aspects of male sexual behavior. Apomorphine may be inhibitory in quail because it acts primarily on D2-like receptors, unlike in rats, where it stimulates sexual behavior and acts primarily on D1-like receptors at low doses but interacts with D2-like receptors at higher doses. This is supported by the observation that stereotyped pecking, a behavior stimulated selectively in quail by D2 agonists, was increased by apomorphine but not by the two indirect agonists. The observed partial dissociation between the effects of these dopaminergic agonists on appetitive and consummatory sexual behaviors suggests that these two components of male sexual behavior may be controlled by the action of dopamine through different neuronal systems.

Differential effects of D1 and D2 dopamine-receptor agonists and antagonists on appetitive and consummatory aspects of male sexual behavior in Japanese quail

Pharmacological studies in Japanese quail based on behavioral tests with a variety of dopaminergic compounds suggest that the activation of D2 dopamine receptors inhibits, and the activation of D1 dopamine receptors enhances, appetitive and consummatory components of male sexual behavior. This hypothesis was tested by studying the behavioral effects of specific D1 and D2 dopaminergic-receptor agonists and antagonists in castrated male Japanese quail chronically treated with exogenous testosterone (subcutaneous Silastic implants). The effects of 5 compounds were tested: 1 D1 (SKF38393) and 2 D2 (PPHT and quinpirole) agonists, and 1 D1 (SCH23390) and 1 D2 (Spiperone) antagonist. All compounds were tested at a low and a high dose (0.1 and 1 mg/kg, respectively, for all drugs, except spiperone where the doses were 2 and 10 mg/kg). A consistent effect of all drugs on consummatory sexual behavior was observed: it was stimulated by the D1 agonist and the D2 antagonist, but inhibited by the D1 antagonist and the D2 agonists. Far fewer effects of the treatments were detected on the measures of appetitive behavior. Measures of appetitive behavior were decreased by the 2 D2 agonists, but not affected by the other treatments. These data suggest that male copulatory behavior in quail is stimulated by dopamine acting on D1 receptors, but inhibited by activation of the D2 receptor subtype. The partial dissociation observed between the effects of the same treatments on appetitive and consummatory aspects of sexual behavior also suggests that these 2 behavioral systems may be controlled by the action of dopamine on different neuronal systems.

Aromatase inhibition blocks the activation and sexual differentiation of appetitive male sexual behavior in Japanese quail

Two experiments investigated the role of estrogens in the activation and sexual differentiation of appetitive sexual behavior (ASB) in Japanese quail (Coturnix japonica) as measured by a learned social proximity response. Injection of the aromatase inhibitor R767 13 in castrated, testosterone (T)-treated male quail completely suppressed ASB, confirming that, like consummatory sexual behavior, ASB is mediated by T aromatization. ASB is not observed in female quail, even if they are treated with T as adults. The role of embryonic estrogens in the sexual differentiation of ASB was tested by blocking estrogen synthesis in ovo. Control male and T-treated female quail deprived of estrogens during embryonic life learned the social proximity response used to assess ASB, whereas control female quail did not, despite the presence of high T. Thus, ASB is demasculinized by the action of embryonic estrogens during ontogeny as is consummatory behavior.

HIV-1 proviral DNA polymerase chain reaction detection in chorionic villi after exclusion of maternal contamination by variable number of tandem repeats analysis

OBJECTIVE

The study of the placental HIV infection in cases of seropositive pregnant women after exclusion of maternal contamination of chorionic villi samples by variable number of tandem repeats (VNTR) analysis.

METHODS

We studied 30 HIV-positive women: 17 terminated their pregnancy (11 in the first trimester and six in the second) and 13 delivered at term (one was a twin gestation). We selected chorionic villi and ruled out maternal contamination by VNTR analysis. DNA from chorionic villi and cord and maternal blood were tested for HIV by PCR. All infants underwent a paediatric follow-up.

RESULTS

All maternal blood samples tested positive for HIV-1 by polymerase chain reaction. No maternal contamination was revealed and HIV was found in six out of 11 first trimester placentas, in all second trimester samples, and in 10 out of 14 at term. Cord blood tested positive in all second trimester cases and in seven out of 14 liveborns. In no case was HIV found in cord blood without infection of the corresponding placenta; conversely, three placentas tested positive but cord blood was negative. Two infants were HIV-positive, 11 were uninfected (one case was lost to follow-up).

CONCLUSION

Our study indicates that HIV-1 can infect the placenta from first trimester onwards. HIV was found in two-thirds of our cord blood samples but it is possible that some viral DNA in cord blood may have come from infected placental cells. Additional studies are needed to assess the source of HIV in cord blood and the possible contribution of placental or maternal cells infected with HIV to vertical transmission of the virus.

Testosterone effects on the neuronal ultrastructure in the medial preoptic nucleus of male Japanese quail

Dorsolateral neurons of the medial preoptic nucleus (POM) of male Japanese quail are sensitive to the plasma levels of testosterone: their volume and optical density in Nissl-stained sections increase in castrated birds treated with testosterone. The present study was performed on castrated male quail treated or not with Silastic implants filled with testosterone to describe the ultrastructural variations induced by testosterone in these neurons. Gonadally intact male birds were included as controls. The ultrastructure of neurons, taken from the dorsolateral portion of the POM, was dramatically affected by the endocrine manipulations. Quantitative evaluations demonstrated a significant decrease in castrated birds of the rough endoplasmic reticulum (RER), of free polyribosomes, of Golgi complexes, and of dense bodies; these changes paralleled the decrease in cell size. The cell size and the percentage of volume occupied by the intracellular organelles in castrated birds treated with testosterone were comparable to values observed in controls. These ultrastructural changes are similar to those observed in neuronal targets for other gonadal hormones, supporting the idea that testosterone stimulates the development of cytoplasmic structures involved in protein synthesis and secretion. In addition, exposure to testosterone affects the synaptic inputs to POM. These ultrastructural changes are presumably related to the physiological effects (e.g., activation of male sexual behavior) exerted by testosterone on this preoptic region.

The incidence of complications after caesarean section in 156 HIV-positive women

OBJECTIVE

To investigate the risks of post-operative complications in HIV-positive mothers who undergo a caesarean section (CS) because the delivery cannot be safely accomplished by the vaginal route or to protect the infant from viral infection.

DESIGN

In a multicentre study, we reviewed the incidence and type of post-operative complications in 156 HIV-positive women who underwent a CS. These results were compared with those observed in an equal number of HIV-uninfected women who matched for the indication requiring a caesarean delivery, the stage of labour, the integrity or rupture of membranes, and the use of antibiotic prophylaxis.

SETTING

Seven teaching hospitals providing obstetrical care for mothers infected with HIV.

RESULTS

We found that six HIV-infected mothers suffered a major complication (two cases of pneumonia, one pleural effusion, two severe anaemia and one sepsis) compared with only one HIV-negative woman who required blood transfusion after surgery. Minor complications like post-operative fever, endometritis, wound and urinary tract infections were significantly more frequent in HIV-positive women than controls. Multivariate analysis revealed that in HIV-infected women the only factor associated with a significant increase in the rate of complications was a CD4 lymphocyte count < 200 x 10(6)/l.

CONCLUSIONS

The results of our study indicate that HIV-positive mothers are at an increased risk of post-operative complications when delivered by CS. The risk of post-operative complications is higher in HIV-infected women who are severely immunodepressed.

Ultrastructural characterization of the sexually dimorphic medial preoptic nucleus of male Japanese quail

The medial preoptic nucleus is a sexually dimorphic structure whose cytoarchitecture, afferent and efferent connections, and functions have been previously described. No detailed ultrastructural study has, however, been performed to date. Here we describe the ultrastructural organization of this important preoptic structure of the male quail. Neuronal cell bodies of the medial preoptic nucleus generally show extensive development of protein-synthesis-related organelles (rough endoplasmic reticulum, polysomes), and of secretory structures (Golgi complexes, secretory vesicles, dense bodies). Previous morphometrical studies at the light-microscopical level have demonstrated the presence of a medial and a lateral neuronal population distinguished by the size of their cell bodies (the medial neurons are smaller than the lateral neurons). The present ultrastructural investigation confirms the difference in size, but no difference has been observed in the ultrastructural organization of the neurons. In both the medial and the lateral part, the nucleus is characterized by a large variety of cell bodies, including some that, on the basis of their ultrastructure, can be considered as putative peptidergic neurons. Close contacts are frequently observed between adjacent cell bodies that are normally arranged in clusters. Various types of synaptic endings are also present, suggesting a rich supply of nerve fibers. A few glial cells are scattered within the nucleus. In view of the crucial role of this region in regulating quail sexual behavior, the large heterogeneity of neurons and of afferent nervous fibers suggest that this region might have an important role in the integration of information arriving from different brain regions.

Treatment with interferon for genital HPV in HIV-positive and HIV-negative women

The administration of interferons can be resorted to, either on its own or in combination with physical destruction methods, when the extent of genital HPV is widespread. Extensive genital HPV involvement is often seen in HIV-positive patients as a consequence of their immunodeficiency. The extension of these lesions may invalidate treatment by physical destruction, while an underlying immunodeficiency renders interferon therapy less efficacious. We studied HIV-positive and HIV-negative patients with a similar HPV involvement of their genital tract and compared the effectiveness of systemically administered alpha 2b and beta interferons in clearing HPV. Our results confirm that interferon therapy will cure most patients with extensive genital HPV when they are HIV-negative. HIV-positive patients with CD4 counts over 400 lymphocytes/mm3 may expect a similar cure rate, but this halves when this critical threshold is crossed. In these severely immunodeficient patients repeated courses of interferon therapy alone or in combination with physical destruction methods may be required to cure HPV infection.