Clinical outcomes of diverticular disease in young adults: results from a tertiary referral center

Introduction

Diverticular disease (DD), commonly associated with the elderly, is becoming more prevalent among younger individuals. This retrospective study aimed to evaluate the differences in the natural history and outcomes between young and old patients with DD.

Methods

Adult patients with DD diagnosed between 2010 and 2022 at an Italian tertiary referral center were enrolled, and their demographic and clinical data were retrieved. The patients were categorized as young or old based on the 25th percentile of the population's age at diagnosis. Univariate and multivariate analyses were performed to assess the association between the collected variables and the age of disease presentation. Additionally, survival analyses were conducted to evaluate the association between the age of diagnosis and clinical outcomes at follow-up, including disease recurrence, hospital access, surgery, and death.

Results

A total of 220 DD patients (with a median age of 66 years, IQR 55-74, and a female-to-male ratio of 1.4:1) were included in the study, comprising 54 patients receiving a diagnosis before the age of 49 years (young DD patients) and 166 patients diagnosed after the age of 49 years (old DD patients). Male sex (57 vs. 36%, p < 0.01), smoking (38 vs. 14%, p < 0.01), and alcohol consumption (54 vs. 38%) were highly prevalent in young patients. The complications at the time of diagnosis, particularly abscesses and free perforations, occurred more frequently in younger patients (p = 0.04). Moreover, young DD patients experienced a higher rate of hospitalization and surgical intervention (p = 0.01 and p = 0.04, respectively) over a median follow-up period of 5 years.

Conclusion

Preventive strategies and prompt diagnosis are crucial in young patients with DD for achieving better disease outcomes and preventing complications.

Diagnostic Delay of Celiac Disease in Childhood

Importance

The extent and factors associated with risk of diagnostic delay in pediatric celiac disease (CD) are poorly understood.

Objectives

To investigate the diagnostic delay of CD in childhood, and to assess factors associated with this delay.

Design, Setting, and Participants

Multicenter, retrospective, cross-sectional study (2010-2019) of pediatric (aged 0-18 years) patients with CD from 13 pediatric tertiary referral centers in Italy. Data were analyzed from January to June 2023.

Main Outcomes and Measures

The overall diagnostic delay (ie, the time lapse occurring from the first symptoms or clinical data indicative of CD and the definitive diagnosis), further split into preconsultation and postconsultation diagnostic delay, were described. Univariable and multivariable linear regression models for factors associated with diagnostic delay were fitted. Factors associated with extreme diagnostic delay (ie, 1.5 × 75th percentile) and misdiagnosis were assessed.

Results

A total of 3171 patients with CD were included. The mean (SD) age was 6.2 (3.9) years; 2010 patients (63.4%) were female; and 10 patients (0.3%) were Asian, 41 (1.3%) were Northern African, and 3115 (98.3%) were White. The median (IQR) overall diagnostic delay was 5 (2-11) months, and preconsultation and postconsultation diagnostic delay were 2 (0-6) months and 1 (0-3) month, respectively. The median (IQR) extreme overall diagnostic delay (586 cases [18.5%]) was 11 (5-131) months, and the preconsultation and postconsultation delays were 6 (2-120) and 3 (1-131) months, respectively. Patients who had a first diagnosis when aged less than 3 years (650 patients [20.5%]) showed a shorter diagnostic delay, both overall (median [IQR], 4 [1-7] months for patients aged less than 3 years vs 5 [2-12] months for others) and postconsultation (median [IQR], 1 [0-2] month for patients aged less than 3 years vs 2 [0-4] months for others). A shorter delay was registered in male patients, both overall (median [IQR], 4 [1-10] months for male patients vs 5 [2-12] months for female patients) and preconsultation (median [IQR], 1 [0-6] month for male patients vs 2 [0-6] months for female patients). Family history of CD was associated with lower preconsultation delay (odds ratio [OR], 0.59; 95% CI, 0.47-0.74) and lower overall extreme diagnostic delay (OR, 0.75; 95% CI, 0.56-0.99). Neurological symptoms (78 patients [21.5%]; OR, 1.35; 95% CI, 1.03-1.78), gastroesophageal reflux (9 patients [28.1%]; OR, 1.87; 95% CI, 1.02-3.42), and failure to thrive (215 patients [22.6%]; OR, 1.62; 95% CI, 1.31-2.00) showed a more frequent extreme diagnostic delay. A previous misdiagnosis (124 patients [4.0%]) was more frequently associated with gastroesophageal reflux disease, diarrhea, bloating, abdominal pain, constipation, fatigue, osteopenia, and villous atrophy (Marsh 3 classification).

Conclusions and Relevance

In this cross-sectional study of pediatric CD, the diagnostic delay was rather short. Some factors associated with risk for longer diagnostic delay and misdiagnosis emerged, and these should be addressed in future studies.

Long-Term Natural History of Autoimmune Gastritis: Results From a Prospective Monocentric Series

INTRODUCTION

The natural history of autoimmune gastritis (AIG) has been poorly described. In this study, we report the long-term natural history and clinical clustering of the full spectrum of AIG, from the potential to the complicated stage.

METHODS

Prospective single-center study conducted in a tertiary referral center. Patients with AIG at any stage (0 = potential; 1 = early; 2 = florid; 3 = severe; and 4 = complicated) were enrolled (January 2000-December 2022). The histopathological evolution, the clinical presentation, and the correlates of evolution of potential AIG were assessed.

RESULTS

Four hundred ninety-eight patients with AIG (mean age 56.7 ± 15.2 years, F:M ratio 2.5:1) were included, of whom 93 experienced potential AIG. The maximum disease duration was 27 years (median 18, interquartile range 14-23), while the overall median follow-up was 52 months (interquartile range 12-95). Age was significantly lower in stage 0 compared with that in the other stages. Accidental histologic evidence and hematologic findings were the most common clusters of diagnosis. The overall median rate of progression was 7.29 per 100 persons/yr (95% confidence interval [CI] 6.19-8.59), while the stage-specific rates of progression were 10.85 (stage 0; 95% CI 7.75-15.18), 14.83 (stages 1-2; 95% CI 11.89-18.49), and 2.68 (stage 3; 95% CI 1.88-3.84). Newly onset neoplastic complications at follow-up occurred in 41/483 patients (8.5%; 23 neuroendocrine tumors and 18 epithelial dysplasia). No cases of adenocarcinoma were noticed. Male sex was associated with a greater likelihood of evolving from potential AIG to overt AIG.

DISCUSSION

AIG is a progressive disorder, with a virtually absent risk of gastric adenocarcinoma. Patients with potential AIG should be monitored because they carry a high risk of evolving into overt AIG.

Demonstrating Agreement between Radio and Fluorescence Measurements of the Depth of Maximum of Extensive Air Showers at the Pierre Auger Observatory

We show, for the first time, radio measurements of the depth of shower maximum (X_{max}) of air showers induced by cosmic rays that are compared to measurements of the established fluorescence method at the same location. Using measurements at the Pierre Auger Observatory we show full compatibility between our radio and the previously published fluorescence dataset, and between a subset of air showers observed simultaneously with both radio and fluorescence techniques, a measurement setup unique to the Pierre Auger Observatory. Furthermore, we show radio X_{max} resolution as a function of energy and demonstrate the ability to make competitive high-resolution X_{max} measurements with even a sparse radio array. With this, we show that the radio technique is capable of cosmic-ray mass composition studies, both at Auger and at other experiments.

Diagnostic delay in symptomatic uncomplicated diverticular disease: an Italian tertiary referral centre study

The magnitude of the diagnostic delay of symptomatic uncomplicated diverticular disease (SUDD) is unknown; we aimed to evaluate SUDD diagnostic delay and its risk factors. SUDD patients diagnosed at a tertiary referral centre were retrospectively enrolled (2010-2022). Demographic and clinical data were retrieved. Overall, patient-, and physician-dependant diagnostic delays were assessed. Univariate and multivariate analyses were fitted to identify risk factors for diagnostic delay. Overall, 70 SUDD patients (median age 65 years, IQR 52-74; F:M ratio = 1.6:1) were assessed. The median overall diagnostic delay was 7 months (IQR 2-24), patient-dependant delay was 3 months (IQR 0-15), and physician-dependant delay was 1 month (IQR 0-6). Further, 25% of patients were misdiagnosed with irritable bowel syndrome (IBS). At multivariate analysis, previous misdiagnosis was a significant risk factor for overall and physician-dependant diagnostic delay (OR 9.99, p = 0.01, and OR 6.46, p = 0.02, respectively). Also, a high educational level (> 13 years) was associated with a greater overall diagnostic delay (OR 8.74 p = 0.02), while previous abdominal surgery was significantly associated to reduced physician-dependant diagnostic delay (OR 0.19 p = 0.04). To conclude, SUDD may be diagnosed late, IBS being the most frequent misdiagnosis. Timely diagnosis is crucial to tackle the burden of SUDD on patients and healthcare.

Limits to Gauge Coupling in the Dark Sector Set by the Nonobservation of Instanton-Induced Decay of Super-Heavy Dark Matter in the Pierre Auger Observatory Data

Instantons, which are nonperturbative solutions to Yang-Mills equations, provide a signal for the occurrence of quantum tunneling between distinct classes of vacua. They can give rise to decays of particles otherwise forbidden. Using data collected at the Pierre Auger Observatory, we search for signatures of such instanton-induced processes that would be suggestive of super-heavy particles decaying in the Galactic halo. These particles could have been produced during the post-inflationary epoch and match the relic abundance of dark matter inferred today. The nonobservation of the signatures searched for allows us to derive a bound on the reduced coupling constant of gauge interactions in the dark sector: α_{X}≲0.09, for 10^{9}≲M_{X}/GeV<10^{19}. Conversely, we obtain that, for instance, a reduced coupling constant α_{X}=0.09 excludes masses M_{X}≳3×10^{13}  GeV. In the context of dark matter production from gravitational interactions alone, we illustrate how these bounds are complementary to those obtained on the Hubble rate at the end of inflation from the nonobservation of tensor modes in the cosmological microwave background.

Diagnostic delay in adult coeliac disease: An Italian multicentre study

BACKGROUND

There are few data regarding the diagnostic delay and its predisposing factors in coeliac disease (CD).

AIMS

To investigate the overall, the patient-dependant, and the physician-dependant diagnostic delays in CD.

METHODS

CD adult patients were retrospectively enroled at 19 Italian CD outpatient clinics (2011-2021). Overall, patient-dependant, and physician-dependant diagnostic delays were assessed. Extreme diagnostic, i.e., lying above the third quartile of our population, was also analysed. Multivariable regression models for factors affecting the delay were fitted.

RESULTS

Overall, 2362 CD patients (median age at diagnosis 38 years, IQR 27-46; M:F ratio=1:3) were included. The median overall diagnostic delay was 8 months (IQR 5-14), while patient- and physician-dependant delays were 3 (IQR 2-6) and 4 (IQR 2-6) months, respectively. Previous misdiagnosis was associated with greater physician-dependant (1.076, p = 0.005) and overall (0.659, p = 0.001) diagnostic delays. Neurological symptoms (odds ratio 2.311, p = 0.005) and a previous misdiagnosis (coefficient 9.807, p = 0.000) were associated with a greater extreme physician-dependant delay. Gastrointestinal symptoms (OR 1.880, p = 0.004), neurological symptoms (OR 2.313, p = 0.042), and previous misdiagnosis (OR 4.265, p = 0.000) were associated with increased extreme overall diagnostic delay.

CONCLUSION

We identified some factors that hamper CD diagnosis. A proper screening strategy for CD should be implemented.

Survival probability during one-year follow-up after index hospitalization for heart failure: an Italian retrospective study

BACKGROUND

Heart failure affects about 64 million people worldwide, and despite the economic resources employed to improve its prognosis, mortality is still alarming. The aim of this study was to investigate the impact of patients' characteristics on survival probability during one-year follow-up after an index hospitalization for heart failure.

STUDY DESIGN

A three-year retrospective study was conducted on the records of the Hospitals belonging the Local Health Unit of L'Aquila, a Healthcare Facility located in the centre of Italy.

METHODS

Patients admitted to hospital with a heart failure event as main diagnosis were selected and followed up for one year after their discharge to obtain data for survival analysis.

RESULTS

During the observational period for 1,929 patients hospitalized with a Heart failure index event, 1,655 (85.8%) of them were discharged alive and followed up for one year after the discharge. Fourteen percent of patients (n = 232) died for reasons related to Heart failure during the follow-up period. Fifty percent of them (n = 116), died within three months from the index hospitalization discharge. Age ≥75 years (HR 3.192, 95% CI 1.964-5.188), discharging to home (HR 0.399, 95% CI 0.297-0.536), length of stay ≥8 days during the index hospitalization (HR 1.533, 95% CI 1.163-2.019), and high education level (HR 0.517, 95% CI 0.273-0.977), were found to be associated with the survival probability.

CONCLUSION

Study results indicate that older patients, especially those with a low educational level, those with longer index hospitalization, and those not sent directly to home, deserve more care and attention after discharge.

Sociocultural overview and predisposing factors of body art in a health promotion perspective: survey on a sample of Italian young adults

Background

The body art (tattoos, body piercing and other aesthetic practices) is increasing at global level and involves different aspects of public health, from epidemiological feature to cultural and psychosocial determinants and regulatory issues. The study is aimed at estimating the prevalence of tattooed and pierced in youth, focusing on emerging profiles.

Study design

A cross-sectional study has been conducted on 575 students at the first year of degree courses of an Italian University.

Methods

Students were asked to fill an online questionnaire. Logistic regression models were evaluated in order to identify predictive factors and determinants of practice (tattoos, piercing, body art).

Results

The 41.9% of participants underwent at least one body art intervention, with a higher prevalence in females. Multivariate logistic regression suggested an association of body art practice with type of school and university course, as well as lifestyle characteristics (smoking, alcohol abuse). In addition, the intention to undergo to body art intervention in the future appeared significantly higher in women and more frequent in apparently 'protected' categories such as medical students and non-problematic alcohol users.

Conclusions

The study confirmed the importance of the surveillance and social and behavioural research on body art practice and suggested different health promotion perspectives, such as early intervention towards adolescents and late intervention towards young adults belonging to lesser risky population groups.

Nurses' and physicians' opinions on end-of-life: a secondary analysis from an Italian cross-sectional study

BACKGROUND

In daily clinical practice, healthcare workers face end-of-life issues, such as futility, which is generally defined as the provision of treatments that do not produce any meaningful benefit for patients.

STUDY DESIGN

To investigate the end-of-life issues according to Italian nurses' and physicians' opinions and to detect any differences between them, a secondary analysis of existing data from a cross-sectional study was conducted.

METHODS

A validated questionnaire was used involving 351 nurses and 128 physicians from four hospitals in Central Italy.

RESULTS

Regarding the definition of futility, nurses mainly focused on agony, suffering, and risks, while physicians paid more attention to the hope of healing. Nevertheless, both were distressed by different aspects of the treatments; in particular, nurses by the 'invasiveness of the treatments' and physicians by the 'over-medicalization of death'. Instead, nurses and physicians similarly recognized patients' right to seek to anticipate the end of life when they are terminally-ill and to express freely their desire not to be revived.

CONCLUSIONS

The description of experiences and opinions of health professionals could represent a valid basis to develop a 'regulatory system' aimed to guide and support daily clinical and nursing activities.

Nurse Competence Scale: psychometric assessment in the Italian context

INTRODUCTION

The Nurse Competence Scale is a tool for evaluating nursing clinical competence. This tool has been used and psychometrically validated previously in different countries but never in Italy. Assessing the validity and reliability of the Nurse Competence Scale in the Italian context has been a strong necessity for many years.

AIM

To test the psychometric properties and evaluate the internal construct validity of the Italian version of the Nurse Competence Scale.

METHODS

This study is a secondary analysis on a database of 698 bachelor nursing students who were trained in different clinical settings at two Italian universities. Internal consistency was examined with Cronbach's alpha coefficients and inter-item analysis, and construct validity was evaluated by Exploratory Factor Analysis with Oblimin rotation with Kaiser normalization, and eventually Confirmatory Factor Analysis.

RESULTS

The results highlighted the necessity for refinements of the Nurse Competence Scale in the Italian Context. The original model of the Nurse Competence Scale (73 items) was not confirmed. The confirmatory factor analysis presented significant values of Chi-squared test = 10942.766, with degrees of freedom being 2.534 and a ratio of χ²/df = 4.318. The Comparative Fit Index value was significant 0.809 and the Normed Fit Index 0.765 was noteworthy too. The value of Root Mean Square Error of Approximation was significant 0.069. The Cronbach's α coefficient for the new scale was excellent (0.922). The exploratory factor analysis resulted in the Italian Nurse Competence Scale composed of 58 items divided into seven dimensions: using the research, professional awareness, ethical values, tutorial functions, professional leadership, educational interventions, and management of care processes.

CONCLUSIONS

The Italian version of the Nurse Competence Scale with 7 dimension and 58 items is an appropriate tool for describing and comparing self-assessed competencies by nurses. Such evaluations could constitute an important contribution to have better educational environments. Self-assessment of competencies can also raise a stronger awareness of individual educational needs.

Analysis of factors potentially associated with nursing students' academic outcomes: A thirteen-year retrospective multi-cohort study

BACKGROUND

Low academic success rates lead to fewer than the required number of nurses entering the national health systems, impacting on the supply of nurses and with negative consequences for global health care since low nurse-to-patient ratios are associated with an increase of patients' adverse outcomes.

OBJECTIVES

This study was mainly aimed at documenting any of the academic outcomes' potential predictors among Nursing Degree Program (NDP) students' characteristics.

DESIGN

A retrospective multi-cohort study was conducted.

PARTICIPANTS AND SETTING

Ten cohorts of nursing students enrolled in a central Italy university were involved.

METHODS

Qualitative and quantitative data on entry characteristics and academic outcomes were retrieved, observing retrospectively 10 cohorts of Italian nursing students for 13 academic years (2004-2017). Multiple regression analyses were conducted to assess if potential predictors reporting a p-value < 0.05 in univariate analyses were independently related to academic outcomes.

RESULTS

A total of 2278 students were enrolled in this study. Multivariate analyses showed that 'female gender', 'having attended classical or scientific upper-secondary school', and 'having higher upper-secondary diploma grade' were associated both with the qualitative outcomes (graduation within the legal duration of NDP) and the quantitative ones (final degree exam grade). The weight of the 'admission-test score' in explaining the variance of academic performances was very low (β = 0.03, 95% CI = 0.01 to 0.05) compared to the 'upper-secondary diploma grade' (β = 0.14, 95% CI = 0.12 to 0.16).

CONCLUSIONS

This evidence should lead to a reflection on the entry-selection methods for NDP, especially in those countries such as Italy, where these methods are essentially based on the entry-test, which in this study was shown to have a very low predictive power for academic outcomes.

Evaluation of the perception of clinical competencies by nursing students in the different clinical settings: an observational study

INTRODUCTION

The university educational sphere has many dilemmas. The question of sufficient knowledge and skills for students to acquire abilities to provide care in different clinical setting is one important dilemma.

AIM

To measure the level of competencies by nursing students and its application in different clinical environments.

METHODS

Nursing students of two Italian universities participated in the research. Data collection took place April to July 2015 using the Nurse Competence Scale. The Strengthening Reporting of Observational Studies in Epidemiology Guidelines was used to describe the study. Pearson's chi-square test, Student's t test, and regression tests were used for statistical analysis.

RESULTS

The questionnaire response rate was 87.27% (n = 698). Most of the nursing students assessed their level of competency as 'good' and evaluated themselves as more competent than their actual nursing role. Students also appraised themselves as competent either via their clinical practices accomplished or in the therapeutic interventions.

CONCLUSION

This study shows that the self-evaluation of the competencies acquired by nursing students in clinical settings in Latium and Abruzzo is of a good standard. This study also affirms that NCS is a valuable and reliable tool to measure clinical competencies in different clinical settings.

Complexity of care: a concept analysis

BACKGROUND

In spite of the high number of tools designed to measure the complexity of care, there is still great diversity in the meaning of this concept.

METHODS

The study was carried out using the concept analysis method as described by Beth Rodgers; 27 international papers were selected using PubMed, Web of Science and CINAHL data sets, without any time constraints.

RESULTS

A number of similar concepts relating to multiplicity, intensity of care and workload were selected. The antecedents were classified according to personal and clinical features of patients, the characteristics of care, the social and organizational features; the tools that emerged measure the risk of complexity of care. Among the consequences, those that emerged were related to patients, operators and organization. The two attributes of complexity of care are connected with measurement, on the one side, and uncertainly, on the other.

CONCLUSIONS

As difficult as it is to define complexity of care, the analysis states that its classification should be targeted at redefining hospital organization.

Microbiological and molecular characterization of extreme drug-resistant carbapenemase-producing Klebsiella pneumoniae isolates

Fifteen Klebsiella pneumoniae clinical isolates showing non-susceptibility to carbapenems and resistant to colistin were collected in an Italian hospital. All isolates resulted negative to AmpC, MBL and ESBL production but positive to modified Hodge test, therefore were evaluated as KPC producers. The presence of blaKPC genes was verified by polymerase chain reaction (PCR) and sequencing. Furthermore, molecular typing was performed by multilocus sequence typing (MLST). PCR analysis and nucleotide sequencing revealed that all 15 isolates carried the blaKPC-3 gene. MLST analysis attributed the isolates from all patients to belong to the sequence type ST512. All isolates showed extensively drug-resistant (XDR) phenotype. The emergence of colistin-resistant K. pneumoniae underscores the implementation of strict control measures to prevent the dissemination of these organisms in hospitals.

Nursing care complexity in a psychiatric setting: results of an observational study

For nurses working in mental health service settings, it is a priority to perform patient assessments to identify patients' general and behavioural risks and nursing care complexity using objective criteria, to meet the demand for care and to improve the quality of service by reducing health threat conditions to the patients' selves or to others (adverse events). This study highlights that there is a relationship between the complexity of psychiatric patient care, which was assigned a numerical value after the nursing assessment, and the occurrence of psychiatric adverse events in the recent histories of the patients. The results suggest that nursing supervision should be enhanced for patients with high care complexity scores.

Request for ethics support in healthcare practices. Reasons and characteristics of Ethics Consultation Service users

BACKGROUND

Ethical problems in healthcare practices are increasing. Therefore, healthcare professionals encounter difficult ethical problems more frequently in their professional activities. For this reason, in several countries Ethics Consultation Services have been created, and a debate concerning their role and organization model has developed. Despite the great interest of healthcare professionals in ethics support, Ethics Consultation Services are scarcely diffused in Italy.

METHODS

A survey was conducted to identify the levels of the nurses' experience and knowledge in the field of ethics and to assess their willingness to use a consultation service to approach ethical issues in healthcare. A questionnaire was administered and completed personally by 374 nurses appropriately instructed beforehand on its use. They were recruited from post-basic training courses at the Faculty of Medicine and Surgery of the University of L'Aquila.

RESULTS

The willingness to recur to an ethical consultation, indicated by 90.3% of respondents, would confirm the hypothesis that the increasing ethical difficulties encountered in healthcare activities determined a greater interest towards this kind of service. The results of the study underline both the need and expectations the nurses have for ethics consultation and support to face ethical difficulties in patient care, and describe the characteristics of potential users.

CONCLUSION

In our country the delay in approaching such problems is in contrast with the marked interest the healthcare professionals have for a possible request for support to face ethical problems in patient care. The study shows the respondents' high degree of appreciation of the contents of an ethics consultation activity and, consequently, it is desirable that the creation of an Ethics Consultation Service takes into consideration the indications given by the potential users, in addition to the experiences coming from other countries.

Synovial fluid OX40T lymphocytes of patients with rheumatoid arthritis display a Th2/Th0 polarization

Rheumatoid arthritis (RA) is an autoimmune disease in which T-cell activation plays a pivotal role in the induction of articular damage. CD4+/OX40+ T cells accumulate in the synovial fluid (SF) of RA patients, which suggests that they are involved in the pathogenesis of the disease. In this study, we assessed the intracellular cytokine production of peripheral blood and SF CD4+ and CD4+/OX40+ T cells from RA patients in order to evaluate their role in this disorder. Our results show that SF CD4+ cells are predominantly interferon gamma (IFN-gamma)-positive and express a Th1-like cytokine pattern. In SF, significantly more CD4+/OX40+ T cells expressed interleukin-4 (IL-4) and IL4/IFN-gamma than IFN-gamma alone. Our data demonstrate that SF CD4+/OX40+ T cells express a Th2/Th0 cytokine profile, which suggests that they are involved in inflammatory responses in RA joints.

The Green model and its relevance to solar UV risk assessment

Computation of sunlight exposure doses allows one to valuate the risk of skin cancer types for which not only the action spectrum but also the dose-response relationship are known. The Green model is particularly appropriate for this purpose since it calculates the solar ultraviolet spectral irradiance through an analytical approach and then makes dose computation easy and fast. However, somewhat lengthy preliminary work is required to trace the entire Green model which is presented in several papers and is quite difficult to find, and to sum up the information concerning quantification of the risk of ultraviolet induced carcinogenesis from the existing experimental and epidemiological literature. This present paper provides a brief but complete description of the Green model and a short review concerning risk assessment of carcinogenesis induced by exposure to sunlight. Thus it summarises all the physical and health-related aspects involved in performing this task by applying the Green model in order to assist an interested researcher to quickly assimilate all the necessary information.

Comparison of somatostatin receptor expression in human gliomas and medulloblastomas

The expression of the five somatostatin receptor subtypes, sst1-5 was compared on tissue containing glial tumours (glioblastomas or oligodendrogliomas), medulloblastomas, and on normal human cortex. By semiquantitative reverse transcription coupled to polymerase chain reaction, the receptor expression profiles were high in cortex and in tissue containing oligodendrogliomas. It was moderate in medulloblastomas. Tissue containing glioblastomas displayed lower expression of somatostatin receptor subtypes, sst1 and sst3 being mostly expressed. By 125I-Tyr0DTrp8 somatostatin-14 or 125I-Leu8DTrp22 Tyr25 somatostatin-28 autoradiography combined with synaptophysin immunohistochemistry, it was possible to differentiate between isolated tumoral cell component infiltrating the cerebral parenchyma (cortex or white matter) and tumoral tissue (without residual parenchyma) in glioblastomas or oligodendrogliomas. Glial tumoral tissue per se presented few somatostatin receptors. By contrast, medulloblastoma tumoral cells exhibited numerous octreotide sensitive somatostatin receptors. sst2 immunocytochemistry demonstrated immunostaining of neuronal cells and neuropile; sst2 and sst3 immunostaining was identified on glioblastoma proliferating vessels endothelial cells and on medulloblastomas tumoral cells. Faint sst2 immunostaining among glial tumoral cells was due to microglia, while glioma cells did not significantly stain. In summary, medulloblastoma tumoral cells express sst2/sst3 receptors at a high level while glioma cells do not. In gliomas, sst expression is restricted to endothelial cells on proliferating vessels (displaying both sst2 and sst3 receptors), including parenchyma and reactive microglia (only sst2). The differential expression of sst2/sst3 receptors on gliomas and medulloblastomas has implications for the therapy of these tumours.

Somatostatin sst2 receptor knock-out mice: localisation of sst1-5 receptor mRNA and binding in mouse brain by semi-quantitative RT-PCR, in situ hybridisation histochemistry and receptor autoradiography

The peptide hormone/neurotransmitter somatostatin (somatotropin release inhibiting factor; SRIF) and its receptors (sst(1)-sst(5)) appear to regulate many physiological functions in the CNS. Semi-quantitative analysis of the densities of mRNA expression for sst(1-5) receptors and SRIF receptor binding sites were established in sst(2) receptor knock-out (KO) mice. Patterns of sst(1-5) receptor mRNA expression were largely conserved for sst(1,3,4) and sst(5) selective oligonucleotide probes; whereas sst(2) signals were completely absent in KO mouse brain. Autoradiographic analysis demonstrated [(125)I]LTT SRIF(28), [(125)I]CGP 23996 (two radioligands known to label all five recombinant SRIF receptors) and [(125)I]Tyr(3)-octreotide (sst(2) and sst(5) receptor selective) binding in wild type (WT) mouse brain sections; yet no specific binding of [(125)I]Tyr(3)-octreotide in KO mice. In contrast, [(125)I]LTT SRIF(28) and [(125)I]CGP 23996 binding was still present in a number of brain areas in KO mice, although to a lesser degree than in those regions where [(125)I]Tyr(3)-octreotide binding was found, in WT animals. The present data suggest first, that both sst(2) receptor protein and mRNA were completely absent in the brain of these KO animals. Second, there was little evidence of compensatory regulation, at the mRNA level, of the other SRIF receptors as a consequence of the sst(2) KO. Third, the absence of any [(125)I]Tyr(3)-octreotide binding, in KO mice, suggests that this particular ligand is selective for the sst(2) receptor subtype (under the conditions utilised); or that sst(5) receptors are only marginally expressed in brain. Fourth, there were regions where the binding of [(125)I]LTT SRIF(28) and [(125)I]CGP 23996 were moderately affected by the sst(2) KO, suggesting that additional SRIF receptors may well contribute to the binding of the aforementioned radioligands. Finally, since the relative distribution of these two ligands were not entirely superimposable, it suggests that their respective selectivity profiles towards the different SRIF receptor subtypes in situ are not identical.

Modulation of potassium current and calcium influx by somatostatin in rod bipolar cells isolated from the rabbit retina via sst2 receptors

Somatostatin (somatotropin release-inhibiting factor, SRIF) receptor subtypes are expressed by several retinal neurons, suggesting that SRIF acts at multiple levels of the retinal circuitry, although functional data on this issue are scarce. Of the SRIF receptors, the sst2A isoform is expressed by rod bipolar cells (RBCs) of the rabbit retina, and in isolated RBCs we studied the role of sst2 receptors in modulating both K+ current (IK) and the intracellular free [Ca2+] ([Ca2+]i) using both voltage-clamp and Ca2+-imaging techniques. SRIF and octreotide (a SRIF agonist that binds to sst2 receptors) inhibited that component of IK corresponding to the activation of large-conductance, Ca2+- and voltage-dependent K+ channels (IBK) and reduced the K+-induced [Ca2+]i accumulation, suggesting that SRIF effects on IBK may have been secondary to inhibition of Ca2+ channels. Octreotide effects on IBK or on [Ca2+]i accumulation were prevented by RBC treatment with L-Tyr8-Cyanamid 154806, a novel sst2 receptor antagonist, indicating that SRIF effects were mediated by sst2 receptor activation. The present data indicate that SRIF may modulate the information flow through second-order retinal neurons via an action predominantly at sst2 receptors, contribute to the proposition that SRIF be added to the growing list of retinal neuromodulators, and suggest that one of its possible roles in the retina is to regulate transmitter release from RBCs.

Expression of somatostatin subtype 1 receptor in the rabbit retina

PURPOSE

To detect mRNAs for somatostatin (somatotropin release-inhibiting factor [SRIF]) receptor subtypes 1 to 5 (sst(1) through sst(5)) in rabbit retinas by reverse transcription-polymerase chain reaction (RT-PCR) and to investigate the distribution of sst(1) by single- and double-label immunocytochemistry.

METHODS

Semiquantitative RT-PCR using sst-specific primers from mouse sequences was performed. sst(1) was localized using a polyclonal antiserum directed to human sst(1) in cryostat sections of retinas from either normal or optic nerve-transected animals. Immunolabeled cell sizes and densities were measured in wholemounted retinas using computer-assisted image analysis. Double-label immunofluorescence was performed using the sst(1) antiserum in conjunction with monoclonal antibodies directed to SRIF, tyrosine hydroxylase (TH), parvalbumin (PV), or gamma-aminobutyric acid (GABA).

RESULTS

With RT-PCR it was found that all five sst mRNAs were expressed in the rabbit retina, with highest levels of sst(1) mRNA. sst(1) immunolabeling was localized to amacrine cells in the proximal inner nuclear layer (INL) of all retinal regions and to displaced amacrine cells in the ganglion cell layer (GCL) of the ventral retina. Some large sst(1)-immunoreactive (IR) somata were also present in the GCL. They were not observed after optic nerve transection. Double-label immunofluorescence showed sst(1) expression by all TH-IR amacrine cells and by other amacrine cells that were neither PV-IR nor GABA-IR. In addition, sst(1) was expressed by all SRIF-containing displaced amacrine cells.

CONCLUSIONS

All five sst mRNAs are expressed in the rabbit retina. The localization of sst(1) suggests that it may mediate SRIF actions onto amacrine (including dopaminergic) and sparse ganglion cells. sst(1) expression in SRIF-IR cells suggests that this receptor may also act as an autoreceptor.

[Systemic paracoccidioidomycosis with central nervous system involvement]

A clinical case of a patient bearing systemic paracoccidioidomycosis with regional ganglionic and oral exposure and later pulmonary involvement is presented. The patient was treated with specific drugs (amphotericin B, itraconazole, sulfamethoxazole-trimethoprim) and followed throughout a 6-year period and eventually died showing an extensive involvement of the central nervous system.

Circulating soluble factor-inhibiting natural killer (NK) activity of fresh peripheral blood mononuclear cells (PBMC) from inflammatory bowel disease (IBD) patients

This study was performed in order to assess the cytotoxic activity, both natural (NK) and antibody-dependent (ADCC), of PBMC from 38 IBD patients and correlate it with their clinical features. Cytotoxicity assays were performed using sensitive target cells for NK and ADCC activities. In some experiments, highly purified NK cells, obtained both by Percoll density gradient and by co-culturing non-adherent PBMC with RPMI 8866 feeder cells, were used as effector cells. Furthermore, we evaluated NK cell parameters such as number, surface expression of adhesion molecules (CD11a/CD18, CD49d and CD54) and response to different stimuli. We observed a decreased NK cytotoxicity of PBMC from IBD patients, both in ulcerative colitis (UC) and Crohn's disease (CD), independently of the clinical activity of disease. In contrast, the ADCC lytic activity was within normal range. The lower NK cytotoxic activity observed in our IBD patients cannot be related to a decreased number of NK cells, surface expression of adhesion molecules, defective response to IL-2 and maturative defect. Decreased NK activity was induced in PBMC of controls when serum of patients was added and this was unrelated to monocyte-derived modulating factor(s). Our data show a decreased natural killing by fresh PBMC from IBD patients. This lower activity seems to be unrelated to a primary NK cell defect, since purified NK cells exhibited normal levels of killing. It might be hypothesized that serum factors, possibly derived from lymphocytes, with inhibitory properties on NK activity, might be functionally active in the blood of IBD patients, thus modulating NK activity.

Somatostatin enhances neurite outgrowth in PC12 cells

The rat pheochromocytoma cell line PC12 forms neurites in response to nerve growth factor (NGF), and it was also reported to extend processes in the presence of somatostatin (somatotropin release-inhibiting factor, SRIF), a neuroactive peptide that seems to act as a morphogenetic factor in the developing nervous system. In the present study, we re-evaluated the effects of SRIF on PC12 cell differentiation. Our results indicate that SRIF alone is ineffective in promoting neurite outgrowth. Instead, SRIF or its analogue, octreotide (a SRIF agonist on the receptor subtypes 2, 3 and 5), potentiates neurite extension induced by NGF. These results suggest that SRIF enhances neurite formation in PC12 cells without directly promoting neurite outgrowth. SRIF potentiation of NGF-induced neurite outgrowth persists at least in part in the presence of pertussis toxin (PTX), suggesting the involvement of PTX-insensitive G-proteins. In addition, protein kinase-dependent pathways are likely to mediate SRIF effects on NGF-induced differentiation.

Chronic exposure to either somatostatin (SS) or octreotide, a long-lasting SS analogue, affects SS expression in the postnatal visual cortex of the rat

The peptide somatostatin (SS) is widely distributed in the mammalian brain where it modulates neuronal activity through interactions with specific membrane-bound receptor subtypes (ssts). Five different ssts were characterized so far (sst1-5) and their selective agonists were developed on the basis of their binding specificity. SS and ssts are transiently expressed in the developing brain, suggesting a functional role of somatostatinergic systems in neuronal maturation. In the present study, we investigated the effects of chronic exposure to either the SS synthetic analogue, SS-14 or octreotide (a long-acting sst2-preferring analogue) on the maturation of SS-immunoreactivity (-ir) in the primary visual cortex of the rat. SS-ir maturation was investigated both by an evaluation of the number of SS-immunoreactive cells and by radioimmunoassay (RIA) to measure the levels of SS in the postnatal visual cortex. In the visual cortex of normal rats, the number of SS-positive cells markedly increased during the second postnatal week and then significantly decreased until the adult value was reached at the third week. Early and repeated intracerebroventricular (i.c.v.) injections of either SS-14 or octreotide prevented the increase in the number of SS-positive cells, with adult values reached at the end of the first postnatal week. Similarly, administration of either SS-14 or octreotide significantly decreased the SS content of the visual cortex, measured at the end of the second postnatal week. These results show that high local concentrations of either SS-14 or octreotide interfere with SS expression in developing cortical neurons in a restricted postnatal period.

Two-dimensional simulation of a high-gain, generalized self-filtering, unstable resonator

The performance of a high-power excimer laser, generalized self-filtering, unstable resonator has been modeled by means of a numerical code. The spectral method and the Rigrod equations are basic to the numerical procedure, which is quite general because it results from an appropriate combination of independent propagation algorithms. The code can be applied to arbitrary resonator geometry and can be used to take account of gain medium inhomogeneities and instability phenomena.

Survival and complications after radical surgery for carcinoma of the rectum

The results of 164 abdominoperineal resections and 87 anterior resections carried out between 1972 and 1985 for cancer of the rectum were reviewed, assessed, and compared. The problems with anterior resection included a 1.1% hospital mortality and a 5.4% anastomotic failure rate in the 73 manual sutures and 28.5% in the 14 mechanical sutures; recurrence rate was 15.4% and the global 5-year-survival was 62%. There was no mortality in the Miles series; the recurrence rate was 4.8% and the 5-year-survival rate was 53.5%. Urogenital complications after Miles were found in 86.9%: urinary alone 10.8%, sexual alone 19.5%, both 56.5%.

[Angiosarcoma of the breast]

Two cases of angiosarcoma of the breast observed in 1981 and 1982 are reported; one of these is still living, but with local recurrence. The pathogenesis, classification, prognosis and therapy of this malignant tumor are analysed. The review of the literature and personal experience seem to suggest that the treatment of choice should be surgical with complementary radiotherapy.