Ustekinumab safety and effectiveness in patients with ulcerative colitis: results from a large real-life study

BACKGROUND

Ustekinumab (UST) is an interleukin-12/interleukin-23 receptor antagonist recently approved for treating ulcerative colitis (UC) but with limited real-world data. Therefore, we evaluated the effectiveness and safety of UST in patients with UC in a real-world setting.

RESEARCH DESIGN AND METHODS

This is a multicenter, retrospective, observational cohort study. The primary endpoints were the clinical remission rate (partial Mayo score, PMS, ≤1) and the safety of UST. Other endpoints were corticosteroid-free remission (CSFR) rate, clinical response rate (PMS reduction of at least 2 points), and fecal calprotectin (FC) reduction at week 24.

RESULTS

We included 256 consecutive patients with UC (M/F 139/117, median age 52). The clinical remission and clinical response rates at eight weeks were 18.7% (44/235) and 53.2% (125/235), respectively, and 27.6% (42/152) and 61.8% (94/152) at 24 weeks, respectively. At 24 weeks, CSFR was 20.3% (31/152), and FC significantly dropped at week 12 (p = 0.0004) and 24 (p = 0.038). At eight weeks, patients naïve or with one previous biologic treatment showed higher remission (p = 0.002) and clinical >response rates (p = 0.018) than patients previously treated with ≥ 2. Adverse events occurred in six patients (2.3%), whereas four patients (1.6%) underwent colectomy.

CONCLUSION

This real-world study shows that UST effectively and safely treats patients with UC.

Use of tofacitinib as first or second-line therapy is associated with better outcomes in patients with ulcerative colitis: data from a real-world study

BACKGROUND

Data regarding the real-world (RW) use of tofacitinib (TOF) in patients with ulcerative colitis (UC) are limited. We aimed to investigate TOF's RW efficacy and safety in Italian UC patients.

RESEARCH DESIGN AND METHODS

A retrospective assessment of clinical and endoscopic activity was performed according to the Mayo score. The primary endpoints were to evaluate the effectiveness and safety of TOF.

RESULTS

We enrolled 166 patients with a median follow-up of 24 (IQR 8-36) weeks. Clinical remission was achieved in 61/166 (36.7%) and 75/166 (45.2%) patients at 8-week and 24-week follow-ups, respectively. The optimization was requested in 27 (16.3%) patients. Clinical remission was achieved more frequently when TOF was used as a first/second line rather than a third/fourth line treatment (p = 0.007). Mucosal healing was reported in 46% of patients at the median follow-up time. Colectomy occurred in 8 (4.8%) patients. Adverse events occurred in 12 (5.4%) patients and severe in 3 (1.8%). One case of simple Herpes Zoster and one of renal vein thrombosis were recorded.

CONCLUSIONS

Our RW data confirm that TOF is effective and safe in UC patients. It performs remarkably better when used as the first/second line of treatment.

Real-world efficacy and safety of vedolizumab in managing ulcerative colitis versus Crohn's disease: results from an Italian multicenter study

BACKGROUND

Vedolizumab (VDZ) can be used to treat refractory ulcerative colitis (UC) and Crohn's disease (CD). We assessed whether there are differences in treating UC vs CD with VDZ.

RESEARCH DESIGN AND METHODS

 Mayo score in UC and the Harvey-Bradshaw Index (HBI) in CD scored the clinical activity. Achievement and maintenance of clinical remission during the follow-up, and safety were the primary endpoints.

RESULTS

729 patients (475 with UC and 254 with CD), median follow-up of 18 (IQR 6-36) months, were enrolled. Clinical remission at the 6^th month of treatment was achieved in 488 (66.9%) patients (74.4% in CD vs 62.9% in UC, p<0.002) while, during the follow-up, no difference was found (81.5% in the UC group and 81.5% pts in the CD group; p=0.537). The clinical remission at the 6^th month of treatment (p=0.001) and being naïve to biologics (p<0.0001) were significantly associated with prolonged clinical remission. The clinical response was significantly higher in UC (90.1%) vs CD (84.3%) (p=0.023), and surgery occurred more frequently in CD (1.9% in UC vs 5.1% in CD, p=0.016).

CONCLUSION

We found differences when using VDZ in UC vs CD in real life. These parameters can help the physician predict this drug's longterm efficacy.

Parental education and youth suicidal behaviours: a systematic review and meta-analysis

AIMS

Lower parental education has been linked to adverse youth mental health outcomes. However, the relationship between parental education and youth suicidal behaviours remains unclear. We explored the association between parental education and youth suicidal ideation and attempts, and examined whether sociocultural contexts moderate such associations.

METHODS

We conducted a systematic review and meta-analysis with a systematic literature search in PubMed, PsycINFO, Medline and Embase from 1900 to December 2020 for studies with participants aged 0-18, and provided quantitative data on the association between parental education and youth suicidal ideation and attempts (death included). Only articles published in English in peer-reviewed journals were considered. Two authors independently assessed eligibility of the articles. One author extracted data [e.g. number of cases and non-cases in each parental education level, effect sizes in forms of odds ratios (ORs) or beta coefficients]. We then calculated pooled ORs using a random-effects model and used moderator analysis to investigate heterogeneity.

RESULTS

We included a total of 59 articles (63 study samples, totalling 2 738 374 subjects) in the meta-analysis. Lower parental education was associated with youth suicidal attempts [OR = 1.12, 95% Confidence Interval (CI) = 1.04-1.21] but not with suicidal ideation (OR = 1.05, 95% CI = 0.98-1.12). Geographical region and country income level moderated the associations. Lower parental education was associated with an increased risk of youth suicidal attempts in Northern America (OR = 1.26, 95% CI = 1.10-1.45), but with a decreased risk in Eastern and South-Eastern Asia (OR = 0.72, 95% CI = 0.54-0.96). An association of lower parental education and increased risk of youth suicidal ideation was present in high- income countries (HICs) (OR = 1.14, 95% CI = 1.05-1.25), and absent in low- and middle-income countries (LMICs) (OR = 0.91, 95% CI = 0.77-1.08).

CONCLUSIONS

The association between youth suicidal behaviours and parental education seems to differ across geographical and economical contexts, suggesting that cultural, psychosocial or biological factors may play a role in explaining this association. Although there was high heterogeneity in the studies reviewed, this evidence suggests that the role of familial sociodemographic characteristics in youth suicidality may not be universal. This highlights the need to consider cultural, as well as familial factors in the clinical assessment and management of youth's suicidal behaviours in our increasingly multicultural societies, as well as in developing prevention and intervention strategies for youth suicide.

Evolution of mammalian longevity: age-related increase in autophagy in bats compared to other mammals

Autophagy maintains cellular homeostasis and its dysfunction has been implicated in aging. Bats are the longest-lived mammals for their size, but the molecular mechanisms underlying their extended healthspan are not well understood. Here, drawing on >8 years of mark-recapture field studies, we report the first longitudinal analysis of autophagy regulation in bats. Mining of published population level aging blood transcriptomes (M. myotis, mouse and human) highlighted a unique increase of autophagy related transcripts with age in bats, but not in other mammals. This bat-specific increase in autophagy transcripts was recapitulated by the western blot determination of the autophagy marker, LC3II/I ratio, in skin primary fibroblasts (Myotis myotis,Pipistrellus kuhlii, mouse), that also showed an increase with age in both bat species. Further phylogenomic selection pressure analyses across eutherian mammals (n=70 taxa; 274 genes) uncovered 10 autophagy-associated genes under selective pressure in bat lineages. These molecular adaptations potentially mediate the exceptional age-related increase of autophagy signalling in bats, which may contribute to their longer healthspans.

Does infant negative emotionality moderate the effect of maternal depression on motor development?

Maternal depression represents an important social/environmental factor in early childhood; however, its effect on children's motor development may vary depending on the role of infants' dispositional variables. The objective of this study is to investigate the effect of the interaction between maternal depressive symptoms in the first two years of a child's life and the child's temperamental negative emotionality on motor development during this time. Using a cross-sectional study, we assessed 272 infants aged 0 to 24 months old and their mothers. We measured the following variables: maternal depression, infant's negative emotionality, and motor development. A three-way interaction effect highlights that negative emotionality in infants and maternal depression together affect children's overall motor growth trajectory. Infants with low negative emotionality display no effect of maternal depression on motor development. Conversely, infants with high negative emotionality seem to be more susceptible to the effect of maternal depression. Specifically, high maternal depression tends to foster the negative effect of infant's negativity on motor development across time, albeit not significantly. Finally, the absence of maternal depression significantly buffers negative temperament in infants. Findings highlighted the importance of integrating different perspectives when describing early motor growth. In fact, only when considering the interdependence of potential predictors their effect on the motor growth significantly emerges. Screening for early temperamental vulnerability might help in tailoring interventions to prevent maternal depression from affecting infants' motor development.

From Low Hematocrit Physiology to Isovolemic Hemodilution

The aim of this study, starting from some concepts of physiology, was to deal with the ever growing question of intentional anemia. Physiology suitably expresses the linear relationship between hematocrit and blood fluidity, and at the same time explains how viscosity and aggregability are important co-factors in the circulation, in disease and in thromboembolic complications. The need to understand how a low hematocrit level, compared to the volemia, is a fundamental requirement in surgery, and even more so in surgery with a high risk of embolism, like orthopedic traumatology surgery. Normovolemic hemodilution was analyzed both for the risks it involves and for how much it sticks to the changes induced by a similar situation on the various organs and apparatus. The authors, based on their experience in the field of anesthesiology, propose an operating schedule to safely perform intentional normovolemic hemodilution, describing the preoperative, intraoperative and finally the postoperative period. In conclusion, the authors advocate a wider use of this technique, confirming its safety in relation to volemia.

Italian translation and cross-cultural comparison with the Childhood Attachment and Relational Trauma Screen (CARTS)

Background: The Childhood Attachment and Relational Trauma Screen (CARTS) is a computer-administered survey designed to assess retrospectively the socio-ecological context in which instances of child abuse may have occurred. To date, studies supporting the validity of the CARTS have only been undertaken in English-speaking North American populations. Validation projects in other countries and cross-cultural comparisons are therefore warranted. Objective: Develop and preliminarily evaluate the psychometric properties of an Italian version of the CARTS on college students and compare such observations to data acquired from Canadian students. Method: Seventy-nine undergraduate students from the University of Padua (Italy) completed an Italian translation of the CARTS as well as measures of childhood experiences, mental health and attachment, responses to which were compared to those obtained in 288 Canadian students who completed the CARTS in English. Results: Internal consistency and convergent validity with the Childhood Trauma Questionnaire and Parental Bonding Instrument were found to be acceptable for the Italian translation. Within the Italian sample, correlation analyses suggested that CARTS Mother ratings referring to attachment and abuse were associated with romantic attachment, whereas CARTS Father ratings were significantly correlated to PTSD symptoms and other symptoms of psychopathology-distress. Significant differences between Italian and Canadian students across the relationship types for the CARTS abuse and attachment scales were found, indicating that Italian students rated their mothers and fathers as simultaneously less abusive, but also less as a source of secure attachment. Conclusions: The results of this preliminary study seem to suggest convergent validity of the Italian CARTS and the association between childhood attachment-related experiences and romantic attachment. Cultural variations were identified between Canadian and Italian students in both attachment and abuse scales. Future studies to investigate cross-cultural variations in the relational context of childhood abuse and in order to boost Italian CARTS psychometric features are warranted.

The ART of mating: alternative reproductive tactics and mating success in a nest-guarding fish

Behavioural observations in the field of male Mediterranean damselfish Chromis chromis were combined with molecular analyses, using bi-parentally and maternally inherited markers, to investigate reproductive success patterns of alternative reproductive tactics (ARTs) in terms of number of eggs sired and number of females contributing to each nest. Cuckoldry was observed in every nest sampled, with at least two and up to seven sneaker males per nest. The nesting male, however, always significantly fertilized the greater number of eggs (on average 49%) in each clutch, whereas each sneaker fertilized around 7% of the clutch. The average number of females whose eggs were fertilized by nesting males was 6·76 (range 2-13), while each sneaker on average fertilized the eggs of 1·74 (range 1-8) females. Using this sibship reconstruction, some of the factors involved in the regulation of the dynamic equilibrium of reproductive success were investigated between the two ARTs shown by C. chromis males. Results show that the sneakers' reproductive success was positively linked to egg clutch size; the density of individuals in the nesting area negatively affected the size of egg clutches; the rate of defence behaviours performed by nesting males negatively influenced the number of females contributing to each nest.

Divergence by depth in an oceanic fish

Despite the striking physical and environmental gradients associated with depth variation in the oceans, relatively little is known about their impact on population diversification, adaptation and speciation. Changes in light associated with increasing depth are likely to alter the visual environment of organisms, and adaptive changes in visual systems may be expected. The pelagic beaked redfish, Sebastes mentella, exhibits depth-associated patterns of substructure in the central North Atlantic, with a widely distributed shallow-pelagic population inhabiting waters between 250 and 550 m depth and a deep-pelagic population dwelling between 550 and 800 m. Here we performed a molecular genetic investigation of samples from fish collected from ‘shallow’ and ‘deep’ populations, using the mitochondrial control region and the gene coding for the visual-pigment rhodopsin. We identify patterns suggestive of potential adaptation to different depths, by detecting a specific amino acid replacement at the rhodopsin gene. Mitochondrial DNA results reflect a scenario of long-term demographic independence between the two S. mentella groups, and raise the possibility that these ‘stocks’ may in fact be two incipient species.

Self-reported sleep disorders in secondary school students: an epidemiological and risk behavioural analysis

PURPOSE

To estimate the prevalence of self-reported sleep disorders (SD), to examine associations among demographic characteristics and familiar factors with SD, between SD and daytime sleep-related disorders (DD) and between evening habits and SD.

METHODS

An anonymous questionnaire was proposed to 1563 students (aged 14-21 years, mean age 16.5 +/- 1.5; 42.8% males, 57.2% females) attending all classes of two high schools in Verona (North-East of Italy). Data were analyzed by some personal and familial characteristics, by definition of three sleeper groups (non problem, occasional problem or problem-sleepers). Moreover SD were put in relation with DD and with some personal evening attitudes.

RESULTS

The 75.5% of the subjects report at least one SD. Difficulty falling asleep is the most frequent SD. The DD concern 91.2% of the sample. Females are more involved than males in SD and DD. All SD result strongly associated with the referred DD, except for sleepiness. Sport is significantly correlated with a minor prevalence of SD. Smoking and studying appear to be associated with SD.

CONCLUSIONS

Since SD in youth constitute an important Public Health matter with a severe social impact they would be accurately studied to offer youth appropriate counselling given the importance of lifestyle in determining good sleep.

Classical swine fever in wild boar in the Lombardy region of Italy from 1997 to 2002

In 1997, outbreaks of classical swine fever occurred in wild boar and domestic pigs in the Italian province of Varese (Lombardy region). Statutory animal health measures were imposed, and a control plan aimed at preventing the virus from spreading outside the infected hunting zone of 108 km2 was implemented. However, in 1998, virologically positive wild boar were found outside this zone, including within Swiss territory. The infected zone was then enlarged to include the three other hunting areas of the northern province of Varese and the neighbouring Swiss territory. Italian and Swiss veterinary services initiated a joint policy to control the disease by hunting young wild boar and conserving older, immune animals. The percentage of virologically positive animals gradually decreased, the last being found in July 2000. The seroprevalence initially increased, but in 2000 and 2001 it decreased from 42.2 per cent to 8.8 per cent, indicating that the wild boar population had had no further contact with the virus.

Effect of inapplicable items in the factor structure of the Spanish version of the Ways of Coping Questionnaire

The aim of this work was to examine how the presence of inapplicable items might change the factor structure of the 1984 Ways of Coping Questionnaire by Lazarus and Folkman. The Spanish version of the Ways of Coping Questionnaire was administered to 156 subjects with university degrees. The 95 women and 61 men whose ages were from 18 and 45 years (M = 27.8, SD = 12.1) were of middle socioeconomic status. All were residents of Buenos Aires. To study whether relevant items modify the factor structure of the Ways of Coping Questionnaire, two factor analyses were carried out, one with items rated as not relevant (Item Mean) and the other with the same items rated as not chosen. In both factor analyses, principal axes method and oblimin rotation were performed, and five factors were considered. Congruence indexes were performed. Analysis showed that not choosing an item because it does not coincide with one's behavior or ideas is not the same as not selecting that item because it does not apply to the current threatening situation. Lack of discrimination between situations when analyzing data leads to a distorted interpretation of the way in which the subject actually behaves or copes with the situation.

[Hormone evaluation in brain death]

BACKGROUND

In this study, the level and the variation of a number of hormone and metabolic parameters during brain death treatment in potential organ donors have been monitored.

METHODS

Thirty-nine consecutive brain-dead patients were enrolled in 3 Intensive Care Units of Regional Hospitals of the North of Italy. All patients were potential organ donors and free from diseases before the accident leading to death. The levels of ADH, ACTH, TSH, prolactin, cortisol, aldosterone, FT3, FT4, renin, serum lactate and plasma osmolality were measured immediately after the diagnosis of brain death (T0), certified following the Italian law of December 29, 1993, n. 578, and after 6 hours (T6).

RESULTS

Hormone levels were normal in the majority of subjects, and there was no significant variation during the 6 hours of the observation period. No correlation was found between the hormone levels considered and the metabolic parameters; ADH levels were not correlated with plasma osmolality. FT3 levels were below the normal range in the majority of subjects, but were not associated with a higher lactate level, which is used as a marker of a shift toward tissue anaerobic metabolism.

CONCLUSIONS

In conclusion, triiodothyronine administration to improve metabolic order and thus the function of organs for transplantation is not justified in brain-dead patients.

[HCV and extrahepatic diseases]

Besides being a hepatotropic virus and a common cause of chronic hepatitis, hepatitis C virus (HCV) has been linked to a variety of extrahepatic immunological manifestations. The high prevalence of HCV infections in some of these conditions suggests an important pathogenetic role of the virus. The recent observation that HCV infects peripheral blood mononuclear cells, such as CD8+ T lymphocytes, CD19+ B lymphocytes and monocytes/microphages, has given an insight into the possible mechanisms of HCV associated autoimmunity. In the clinical practice it is recommended not only to search for symptoms and signs of autoimmune disorders in patients with chronic hepatitis C, but also to test for hepatitis C virus infection patients with extrahepatic conditions known to be related to HCV. Even if the occurrence of autoimmune disorders or the exacerbations of autoimmune diseases has been reported during interferon therapy, antiviral therapy is effective in treating some of the extrahepatic disorders associated with HCV, namely mixed cryoglobulinemia and membranoproliferative glomerulonephritis. The extrahepatic manifestations associated with hepatitis C virus infection are reviewed according to the available data and the option of interferon therapy is discussed.

Inhibition of cell proliferation by the interferon-inducible 204 gene, a member of the Ifi 200 cluster

The role of the IFN-inducible p204 as growth regulator was investigated by transfecting an expression vector constitutively expressing p204 into several cell lines. Like pRB and p107, p204 is a potent growth inhibitor in sensitive cells, as demonstrated by the cell focus assay. Since stable transfectants of sensitive lines constitutively overexpressing p204 could not be established in vitro, we inserted the 204 cDNA into a vector bearing an heavy-metal-inducible promoter. Here we show that proliferation of B6MEF fibroblasts lacking endogenous p204 is strongly inhibited by transient p204 expression in the nucleus. p204 delays G1 progression into the S-phase and cells accumulate with a DNA content equivalent to cells arrested in late G1. Moreover, the role of p204 in the control of cell growth in vivo was investigated by generating transgenic mice in which the Ifi 204 gene was constitutively expressed in all tissues. To this end, expression vectors bearing the 204 cDNA under the control of the SV40 viral promoter were constructed. The overexpression of the p204 transgene achieved by injecting fertilized mouse eggs with these vectors was compatible with embryo development up to the four-cell stage in an in vitro follow-up of 4.5 days. However, no viable animals with an intact copy of the transgene were obtained, suggesting that high and constitutive levels of p204 expression can impair normal embryo development. These findings indicate that p204 plays a negative role in growth regulation and provide new information about the molecular mechanisms exploited by IFNs to inhibit cell proliferation.

Suppression of high mobility group protein T160 expression impairs mouse cytomegalovirus replication

The high mobility group (HMG-1) box proteins bind both non-B-DNA conformations and specific nucleotide sequences. They have been implicated in a wide variety of cellular functions involving DNA, such as transcription, replication and recombination. To determine whether HMG-1 box protein T160 plays a role in virus replication, we employed an antisense strategy to inhibit its expression in NIH 3T3 cells. The two T160 clones that expressed levels of T160 50% lower than those expressed by clones transfected with the empty vector (Neo+ clones) were investigated with respect to their permissiveness to the growth of viruses representing three families: Rhabdoviridae, vesicular stomatitis virus (VSV); Picornaviridae, encephalomyocarditis virus (EMCV), and Alpha- and Betaherpesviridae, herpes simplex virus 1 (HSV-1) and mouse cytomegalovirus (MCMV), respectively. They displayed a high degree of resistance to MCMV replication, but were fully permissive to the other viruses. Competitive PCR and probing IE-1 products by Western blot analysis showed that this resistance was not due to depressed levels of virus adsorption during the early phases of infection. We therefore conclude that T160 is involved in replication of the betaherpesvirus MCMV.

From low hematocrit physiology to isovolemic hemodilution

The aim of this study, starting from some concepts of physiology, was to deal with the ever growing question of intentional anemia. Physiology suitably expresses the linear relationship between hematocrit and blood fluidity, and at the same time explains how viscosity and aggregability are important co-factors in the circulation, in disease and in thromboembolic complications. The need to understand how a low hematocrit level, compared to the volemia, is a fundamental requirement in surgery, and even more so in surgery with a high risk of embolism, like orthopedic traumatology surgery. Normovolemic hemodilution was analyzed both for the risks it involves and for how much it sticks to the changes induced by a similar situation on the various organs and apparatus. The authors, based on their experience in the field of anesthesiology, propose an operating schedule to safely perform intentional normovolemic hemodilution, describing the preoperative, intraoperative and finally the postoperative period. In conclusion, the authors advocate a wider use of this technique, confirming its safety in relation to volemia.

Urologist: Clinical information system for urology

“Urologist” was developed to run a Department of Urology. A local area network (LAN), one server and five stations, connects the single functional units of the Department (O.R.; I.C.U.; wards; Spinal Unit and Patient services). A Patient Identification Card integrates both clinical and organisational data. A multidisciplinary group, consisting of medical and non-medical specialists, was necessary to develop this system.

The role of apoptosis in growing and stationary rat ascites hepatoma, Yoshida AH-130

The occurrence of apoptosis and its contribution to growth-phase transitions in the rat ascites hepatoma Yoshida AH-130 have been evaluated. Apoptosis was observed by light microscopy in both exponentially-growing and stationary tumours as characteristic chromatin condensation and compacting of the cytoplasm, but the frequency of apoptotic bodies (apoptotic index) was four-fold higher in stationary than in logarithmic-growing tumours. Apoptosing cells exhibited strong immunocytochemical reactivity for 'tissue' transglutaminase, and transglutaminase activity was higher in stationary tumour cells. A ladder pattern of DNA fragmentation was revealed by agarose gel electrophoresis which was more pronounced in stationary tumours. The apoptotic bodies were either free or contained in vacuoles within otherwise normal tumour cells, suggesting active engulfment of dead cells by viable homologous cells. Such 'homophagic' disposal of the apoptotic bodies probably accounted for a component of the enhanced cell protein degradation previously observed in stationary AH-130 tumours (Tessitore L, Bonelli G, Cecchini G, Amenta JS, Baccino FM, Arch Biochem Biophys 1987; 255: 372-384). The data indicate that, in concurrence with changes in the cell proliferation rate, modulations of apoptosis play a substantial role in determining the net growth rate of such an anaplastic tumour as the Yoshida AH-130 hepatoma.

Cell death induced in L-cells by treatment with thymidine: staging of the process and relationship to apoptosis

The purpose of this study was to characterize the stages in the development of thymidine-induced cell death. L-cells were characterized by both morphologic and quantitative techniques and evaluated at 24, 48, and 72 h of treatment. Cells first enlarged (stage I); about 50% of these enlarged cells then decreased in size with blebbing and compacting (stage II). This residual cell body transformed into a smooth eosinophilic hyaline body (stage III) by 72 h, many of which could be identified within the vacuolar system of viable cells. These changes were reflected in morphologic counts and Coulter sizing. Cell death (loss of labeled DNA) began in stage II and was most prominent in stage III. No cleavage of DNA into oligonucleosomal fragments was detected by agarose gel electrophoresis at any stage. The similarity of these changes to the complete spectrum of apoptosis in vivo is discussed.

Surgical Treatment of Renal Cell Carcinoma with Vena Cava Or Cavo-Atrial Involvement. Our Experience

From January 1987 to September 1992, 290 patients were operated for renal cell carcinoma at the Department of Urology of Bergamo General Hospital. Among these, 22 had venous invasion, 13 of them with vena cava or cavo-atrial involvement. The Authors stress several technical details that they judge very helpful in the case of intrahepatic or supradiaphragmatic thrombi. Among them the routine use of transesophageal sonography, which gives precise details on the size, volume, and upper limit of the thrombus especially if floating. 4 patients were operated with the help of cardiopulmonary by-pass, circulatory arrest and profound hypothermia. The Authors stress the major advantages offered by this technique compared to simpler approaches like the control either of the supradiaphragmatic vena cava, or hepatic veins. Cardiopulmonary by-pass and circulatory arrest offers unsurpassed exposure of the IVC interior and allows easy and controlled extraction of the thrombus, previously the most difficult part of the procedure. Having no time limit imposed by liver ischemia (± 20 minutes), it also offers the possibility of resecting segments of caval wall and repairing it with patch grafts. Among 13 patients who underwent radical nephrectomy and intracaval thrombus removal, limited complications and no peri-operative mortalities are reported.

[Tracheal intubation: increase of arterial pressure and cerebral blood flow velocity. Effect of thiopentone and propofol]

Induction of anaesthesia in intracranial surgery, especially for vascular diseases, must minimize haemodynamic changes: blood pressure and cerebral blood flow must not be increased to a high degree. Our work compares increases in blood pressure and in the speed of cerebral blood flow during endotracheal intubation in two groups of patients, who received propofol or thiopentone for the induction of anaesthesia. We studied 30 patients, without intracranial diseases, who underwent lumbar slipped disk surgery. Half of the patients received thiopentone and curare before intubation and the other half propofol and curare. Increase in blood pressure after intubation was lower with propofol than with thiopentone in a statistically significant way. Also the increase in the speed of cerebral blood flow, measured with doppler technique, was lower when induction with propofol was used, though not statistically relevant.

The problem of blood in surgical treatment of spinal deformity

In order to minimize the risks of homologous blood transfusion during surgery for spinal deformity, we perform a blood-saving procedure consisting of both intraoperative methods and auto-transfusion techniques. In this paper we compare our experience in the year 1989 with that of the past decade. When auto-transfusion was used, there was a decrease in intraoperative blood loss and only 4% of the patients required homologous transfusions.

[Activity of topical flunoxaprofen in nonspecific vaginitis. Comparison with meclocycline sulfosalicylate]

A trial was performed in 30 patients affected by non-specific vaginitis. The results show that the topical application (by vaginal washings) of flunoxaprofen produces a high therapeutic activity like that of meclocycline. Contrary to meclocycline, flunoxaprofen does not possess bactericidal and bacteriostatic properties. Therefore, the normalization of vaginal flora, with a remarkable increase of Döderlein bacillus, is exclusively due to local antiphlogistic activity of flunoxaprofen. Contrary to meclocycline, flunoxaprofen induces a precocious increase of Döderlein bacillus, necessary for a definitive normalization and to limit the possibility of relapses.

Flunoxaprofen, a new non-steroidal anti-inflammatory drug, does not interfere with prostaglandin synthesis in rat gastric mucosa

The anti-inflammatory activity and the eicosanoid generation in rat gastric mucosa after a single oral dose of S-(+)-2(4-fluorophenyl)-alpha-methyl-5-benzoxazolacetic acid (flunoxaprofen, 10 mg/kg) or indomethacin (5 mg/kg) were compared. The two compounds, at the dose used, show a similar degree of anti-inflammatory activity (50% inhibition of carrageenan-induced oedema in rat paw). Moreover flunoxaprofen does not modify the formation of 6-keto-PGF1 alpha by rat gastric mucosa in vitro while indomethacin causes 50% inhibition of gastric cyclooxygenase activity. This biochemical change induced by indomethacin is associated with gastric lesions. Chronic treatment of rats with flunoxaprofen (5 or 50 mg/kg p.o. for 15 days) shows an anti-inflammatory activity in the range of 60-70% inhibition in the rat paw oedema test without gastric mucosa damages and prostaglandin synthesis inhibition.

Stereochemical pharmacokinetics of the 2-arylpropionic acid non-steroidal antiinflammatory drug flunoxaprofen in rats and in man

Stereospecific serum assays of the non-steroidal antiinflammatory drug flunoxaprofen (S(+)-2-(4-fluorophenyl)-a-methyl-5-benzoxazoleacetic acid, Priaxim) were performed in rats after the oral administration of 10 mg/kg b.w. of the different enantiomeric forms of the drug or of the racemate in order to establish the occurrence and the rate of biotransformation of R(-)-flunoxaprofen to the S(+)-enantiomer, which is the pharmacologically active form. Preliminary observations of the enantiomeric blood levels were also made in man after a single oral dose (100 mg) of R(-)-flunoxaprofen or of the racemate. Blood was withdrawn at different time intervals up to 120 h in rats and up to 48 h in man and serum levels of flunoxaprofen enantiomers were determined by a HPLC method. The results obtained in the rat show that S(+)-flunoxaprofen serum levels following the administration of a single oral dose of flunoxaprofen reach about the same values (between 24 and 30 micrograms/ml at 18 h) whichever form was dosed (i.e. 10 mg/kg b.w. of S(+)- or R(+)-, or 5 mg/kg b.w. of S(+)- as the racemate). On the contrary, R(-)-flunoxaprofen serum concentrations fall to values lower than 5 micrograms/ml either after the administration of 10 mg/kg R(-)- or of 5 mg/kg R(-)- as the racemate; these serum R(-)-flunoxaprofen values are close to those observed after the administration of S(+)-flunoxaprofen which contains 5% R(-)- as an impurity (i.e. 0.5 mg/kg b.w.).(ABSTRACT TRUNCATED AT 250 WORDS)

Peripheral neuropathy associated with experimental plasma cell neoplasm in the mouse

In order to investigate the role of paraproteins in the production of neuropathy we experimentally induced monoclonal immunoglobulin-producing tumours into 32 BALB/c mice by injecting mineral oil or pristane intraperitoneally. In 11 mice morphologic and histometric studies of the sciatic nerve revealed the presence of neuropathy. Immunohistochemical studies did not demonstrate a significant amount of immunoglobulins and light chains in the endoneurium. The advantages and limits of this experimental model are discussed.

The effects of PGF2 alpha on respiratory and cardiovascular variables in pig

PGF2 alpha was injected into different parts of the circulatory system (intravenously by femoral and jugular veins, into the pulmonary artery, into the ascending or descending aorta and into the internal carotid artery at a level above the sinus and carotid body) of anaesthetized spontaneously breathing pigs. It caused changes in respiratory and cardiovascular variables. In vagosympathectomized animals the changes in pattern of breathing produced by PGF2 alpha were greatly reduced and total lung resistance was increased. This may indicates more than one site of action of PGF2 alpha, lung resistance being influenced by a direct action of PGF2 alpha and by an immediate reflex while the pattern of breathing being modulated by vagal efferents from the lungs.

[Respiratory work in panting in swine]

The dynamic work of breathing (Wdyn) has been measured during thermal tachypnea in pig anaesthetized and tracheotomized. During euthermia Wdin(cm H2O/R1/min-1) increases with ventilation (L.P.S.) according to Wdyn = 1,09 V2 + 1,33 V3; when body temperature rose above 39 degrees C for a given ventilation Wdyn decreases. In all animals has been observed a change of airways size and probably of respiratory tract of Weibel.

[Thermal tachypnea in pigs]

In anaesthetised and tracheotomised pig, the reflex of panting has been evaluated. The thermal tachypnea showed two phases: initially respiratory frequency increases likely to body temperature but at 41,4 degrees C is observed apnea. When temperature rose above 42 degrees C the respiratory frequency further increased the changes in blood CO2, O2 and pH were not significant. During apnea is present a slight alkalosis.