A role for intracellular zinc in glioma alteration of neuronal chloride equilibrium

Glioma patients commonly suffer from epileptic seizures. However, the mechanisms of glioma-associated epilepsy are far to be completely understood. Using glioma-neurons co-cultures, we found that tumor cells are able to deeply influence neuronal chloride homeostasis, by depolarizing the reversal potential of γ-aminobutyric acid (GABA)-evoked currents (EGABA). EGABA depolarizing shift is due to zinc-dependent reduction of neuronal KCC2 activity and requires glutamate release from glioma cells. Consistently, intracellular zinc loading rapidly depolarizes EGABA in mouse hippocampal neurons, through the Src/Trk pathway and this effect is promptly reverted upon zinc chelation. This study provides a possible molecular mechanism linking glioma invasion to excitation/inhibition imbalance and epileptic seizures, through the zinc-mediated disruption of neuronal chloride homeostasis.

KCa3.1 channels are involved in the infiltrative behavior of glioblastoma in vivo

Glioblastoma multiforme (GBM) is a diffuse brain tumor characterized by high infiltration in the brain parenchyma rendering the tumor difficult to eradicate by neurosurgery. Efforts to identify molecular targets involved in the invasive behavior of GBM suggested ion channel inhibition as a promising therapeutic approach. To determine if the Ca(2+)-dependent K(+) channel KCa3.1 could represent a key element for GBM brain infiltration, human GL-15 cells were xenografted into the brain of SCID mice that were then treated with the specific KCa3.1 blocker TRAM-34 (1-((2-chlorophenyl) (diphenyl)methyl)-1H-pyrazole). After 5 weeks of treatment, immunofluorescence analyses of cerebral slices revealed reduced tumor infiltration and astrogliosis surrounding the tumor, compared with untreated mice. Significant reduction of tumor infiltration was also observed in the brain of mice transplanted with KCa3.1-silenced GL-15 cells, indicating a direct effect of TRAM-34 on GBM-expressed KCa3.1 channels. As KCa3.1 channels are also expressed on microglia, we investigated the effects of TRAM-34 on microglia activation in GL-15 transplanted mice and found a reduction of CD68 staining in treated mice. Similar results were observed in vitro where TRAM-34 reduced both phagocytosis and chemotactic activity of primary microglia exposed to GBM-conditioned medium. Taken together, these results indicate that KCa3.1 activity has an important role in GBM invasiveness in vivo and that its inhibition directly affects glioma cell migration and reduces astrocytosis and microglia activation in response to tumor-released factors. KCa3.1 channel inhibition therefore constitutes a potential novel therapeutic approach to reduce GBM spreading into the surrounding tissue.

Quality of life in alopecia areata: a disease-specific questionnaire

BACKGROUND

Alopecia areata (AA) is an autoimmune disease affecting about 2% of the population, which has a considerable impact on quality of life (QoL). There are no disease-specific questionnaires to assess QoL in patients suffering from AA.

OBJECTIVE

To validate a new disease-specific questionnaire for AA, named AA-QLI, and to compare the consequent Quality of Life Index (QLI) with the commonly known Dermatology Life Quality Index (DLQI) to verify if it can provide a more comprehensive tool for patients.

METHODS

A total of 50 patients affected by AA were administered both the AA-QLI, created by us, and the well-known DLQI. With the aim to detect suitable QLI, we propose to use two multivariate analyses: • a principal component analysis approach on the data collected with both questionnaires to compare their capability to measure the QoL; • a structural equation modelling on our AA-QLI to identify which category of symptoms mostly affects the QoL.

RESULTS

The scores of both the questionnaires are quite close, except for a few cases. Statistical analysis shows a higher specificity of the AA-QLI for evaluating QoL. Among the three areas in which AA-QLI is divided, 'Relationship' has a major impact on the QLI, followed by 'Subjective symptoms'; 'Objective signs' has a lower weight on the QLI.

CONCLUSION

AA-QLI is a good instrument to evaluate the real impact of AA on QoL. It can be helpful both for the physician and for the patient.

Nicotinic cholinergic stimulation promotes survival and reduces motility of cultured rat cerebellar granule cells

Despite many studies on the functional expression of neuronal nicotinic acetylcholine receptors (nAChRs), an exhaustive description of the long-term effects of nicotine (Nic) stimulation in cerebellar granules is still far to be completed. For this reason, we addressed the experiments stimulating cultured cerebellar granule neurons (CGN) with Nic, focusing on the effects on cell motility and survival. Using electrophysiological and Ca(2+)-fluorescence techniques, we found a subset of rat CGN that responded to Nic by inward whole cell currents and by short-delay Ca(2+) transients. These responses were mediated through both homomeric and heteromeric nAChRs, as assessed by their sensitivity to alpha-bungarotoxin (alpha-BTX), dihydro-beta-erythroidine (DHbetaE), methyllicaconitine (MLA) and 5-hydroxyindole (5OH-indole). Once established the expression of alpha-BTX-sensitive and insensitive nAChRs and their ability to trigger Ca(2+) responses in CGN, we aimed at investigating their possible role on cell survival and motility. We demonstrate that Nic stimulation significantly increases the survival of CGN exposed to the apoptosis-promoting low K(+) medium. This anti-apoptotic effect is likely mediated through alpha7* nAChRs since we found that it was mimicked by choline, was insensitive to DHbetaE and was fully inhibited by alpha-BTX. Furthermore, we report that Nic negatively modulates CGN motility, reducing the basal cell movement through a pored membrane by the activation of alpha-BTX-insensitive nAChRs. We conclude that CGN express various types of nAChRs, which are differently involved in regulating Nic-mediated modulation of cell survival and migration, and we suggest potential regulatory roles for cholinergic receptors during cerebellar development.

[Treatment of ovarian carcinoma with intraperitoneal administration of interferon alpha 2b]

BACKGROUND

Pharmacokinetic studies have confirmed that for many chemotherapeutic agents a substantial pharmacological advantage can be achieved using the intraperitoneal route. Aim of this study is to evaluate the efficacy of intraperitoneal interferon alpha 2b chemotherapy to treat ovarian cancer.

METHODS

Forty-four patients affected by ovarian cancer have been submitted to intraperitoneal interferon alpha 2b chemotherapy from October 1989 to May 1996 at the Gynecology and Obstetric Institute of the Second University of Naples. Intraperitoneal route has been obtained through a catheter in left iliac fossa. Drugs have been solved in 2000 ml of physiologic solution to obtain a better distribution into the peritoneal fluid.

RESULTS

Three patients of 15 not-pre-medicated and 16 of 24 pre-medicated have obtained complete anatomo-pathological resolution. No compliances have been checked about catheter. Only two patients have stopped the therapy for asthenia; all the others have well tolerated interferon.

CONCLUSIONS

Our study shows the very low toxicity of interferon associated to a good tolerance of the intraperitoneal catheter and therefore we retain that intraperitoneal chemotherapy with interferon alpha 2b improves the prognosis of patients with minimal ovarian cancer after systemical chemotherapy.

[Role of echo-guided aspiration of ovarian cysts. Our experience]

BACKGROUND

Ultrasound-guided puncture is a simple and easy to perform procedure. This study was undertaken to verify the role of fine-needle aspiration (FNA) followed by cytological examination as a possible alternative to surgery in case of cystic pelvic masses. Ovarian cysts are conventionally managed by laparoscopy or laparotomy.

METHODS

From January 1993 to December 1997, 224 patients with a proven cystic pelvic mass underwent surgical intervention and have been retrospectively analysed for FNA under sonographic guidance. The sediment aspirated was examined by a cytological method and when possible it was also correlated to a histological test.

RESULTS

Eight patients (34.8%) had been submitted to one needle cyst aspiration before surgical intervention and 15 (65.2%) to more than one aspiration. Patients with an history of only one aspiration were submitted to surgical intervention with urgency statistically more than the group with an history of more than one aspiration. Anatomo-pathologic examination showed a significative relevance of serous and endometriotic cysts.

CONCLUSIONS

We conclude that FNA might be proposed in young women with a unilocular ovarian cyst to avoid a surgical procedure. In all instances the ultrasonographic appearance of the cyst and the characteristics of aspirated fluid are the most important findings.

[Role of Ca 125 in pelvic masses. Our experience]

BACKGROUND

The goal of our study is to plan a screening program for early detection of ovarian cancer through clinical examination, pelvic ultrasonography and serum Ca 125 dosage.

METHODS

Between January 1993 and June 1999, 436 patients have been submitted to ovarian cancer screening at the Obstetrics and Gynecology Institute of the Second University of Naples. All women were in postmenopausal period, older than 50 years and didn't show any gynecologic disease.

RESULTS

Clinical examination selected 41 patients (9.4%) with a pelvic mass; pelvic ultrasonography revealed ovarian or uterine mass (only subserous myoma) in 87 cases (19.9%). These patients were submitted to Ca 125 serum dosage; in three cases Ca 125 was higher than 65 U/ml and in 26 cases its value was between 35 and 65 U/ml. The remaining 58 patients showed Ca 125 values lower than 35 U/ml. Four patients with ovarian cancer have been detected with our screening program.

CONCLUSIONS

The authors conclude that pelvic ultrasonography and serum Ca 125 dosage are useful for the assessment of an early screening program of ovarian cancer.

[Evaluation of partners of women with HPV infection]

BACKGROUND

The authors report the results of a clinical-peniscopic study of the genital regions in the male sexual partners of woman with proven genital Human Papilloma Virus (HPV) infection because of its contagiousness, incidence rate and relation with premalignant lesions.

METHODS

From January 1998 to March 1999, 137 sex partners of women with HPV genital infection were investigated by clinical evaluation, cytologic examination of a urethral brushing and peniscopy at the Cervico-vaginal Pathology Center of the Gynecology and Obstetrics Institute of the Second University of Naples. All patients with a clinical and/or peniscopic evidence of infection were submitted to biopsy for histologic examination.

RESULTS

On peniscopy 29.9% (41 patients) of men presented lesions either typical of suspicious for HPV infection at the first and/or at the second control.

CONCLUSIONS

These data confirm that HPV infection, as all sexually transmitted diseases, needs a prevention and control program involving male and female to obtain a good recovery rate and a lowest diffusion.

Inhibitory effect of exogenous oxytocin on ACTH and cortisol secretion during labour

Complex mechanisms which are still not completely defined, are responsible for the spontaneous onset of labour: an essential role is attributed to endocrine factors. A massive increase, even three times higher than normal physiological values of ACTH and cortisol, has been reported during labour. Similar behaviour has also been recorded for oxytocin at the end of pregnancy as well as during labour. The relationship between oxytocin and the adrenal axis are still debated thus the goal of our study was to attempt to clarify this rapport. Sixty-two women at the end of a term-pregnancy agreed to participate in this study: 46 were innoculated with oxytocin (syntocinon) every 20 minutes for 1 hour; 16 were administered a natural placebo every 20 minutes for 1 hour (control group). ACTH and cortisol values from plasma samples were taken every 20 minutes and analyzed. Our results demonstrated an inhibitory effect of exogenous oxytocin on ACTH and cortisol release. This inhibitory effect, as shown by our results, is time and dose-related. High oxytocin levels, as during exogenous infusion, could induce an effect opposite a normal physiologic one.

[Appendectomy: evaluation of medical record maintenance in a series of 200 cases]

To improve the management of appendicular syndromes, two hundred files of patients undergoing appendectomy in an emergency surgery department between January 1993 and August 1994 were submitted to a retrospective and descriptive study with evaluation of the medical file content. To evaluate clinical and investigations data collecting, a histopathological review protocol was elaborated to obtain an objective and reliable criterion of the degree of inflammation of the appendix. This review was possible only for 197 files that were included. Data collecting rates are inferior than expected rates, particularly for the association of temperature, abdominal defence and white blood cells count that was found in only 159 files (80.7%). Data were less collected for women, patients operated by celioscopy and when histopathologic review concluded to absence of acute inflammation. Rate of acute appendicitis was 73.6% (145/197). Appendectomies without acute inflammation were higher for women (34.6% = 37/107) than for men (16.7% = 15/90) and for patients who underwent celioscopic appendectomy (42.9% = 33/77) than for patients who underwent Mac Burney appendectomy (16% = 19/119). These results highlight the need to improve competition of medical files with better collection of clinical data, which could lead to improve care quality and management of operated appendicular syndromes, first step to a reduction of the number of appendectomies. A global assessment of file completion could be proposed on the basis of clinical audit.

[Ogilvie syndrome. Report of two cases]

Ogilvie's syndrome or intestinal acute pseudo-obstruction is a rare form of intestinal obstruction, and is characterised by a dilatation of the distal colon and often of the tenue. The etiology of this syndrome is recognized as a block of sacral parasympathetic after abdominal surgery. We report two cases of post-cesarean section Ogilvie's syndrome verified at "Ospedale S. Maria del Popolo degli Incurabili", in March 1991 and June 1993 both resolved with a new surgery, after failure of the medical and the parendoscopic decompression treatment.