P190 CAROTID DOPPLER ULTRASONOGRAPHIC AND DAPAGLIFOZIN IN TYPE 2 DIABETIC PATIENTS

Background

Carotid Doppler ultrasonography (USG) is widely used to measure haemodynamic parameters, such as Intima–Media Thickness (IMT) and blood flow velocities (i.e. Peak–Systolic Velocity [PSV], End–Diastolic Velocity [EDV], and Resistive Index [RI]). Dapaglifozin (SGLT2i) have been shown to reduce the risk of cardiovascular disease in type 2 diabetes (T2DM) patients. SGLT2i is a sodium–glucose co–transporter 2 inhibitor that reduces renal glucose reabsorption, thus increasing urinary glucose excretion. This leads to sustained systolic and diastolic blood pressure reduction, through natriuresis. We hypothesized that this agent would also reduce arterial stiffness.

Aim

The purpose of this study was to evaluate cardiovascular disease risk indirectly through USG of carotid artery vascular markers in T2DM patients using dapagliflozin.

Methods and Results

40 patients presenting to our clinic between march 2019 and march 2021 and diagnosed with T2DM were included in the study. These were divided into two groups : 1) a dapagliflozin group of 20 patients and 2) 20 patients non–dapagliflozin control group. Velocity parameters were: peak–systolic velocity (PSV), end–diastolic velocity (EDV), pulsatility index (PI), resistive index (RI). Examination was performed on distal portion of CCA, and we took the mean of both CCA. The mean duration of follow–up was 2.0 years. Mean ages were 55 ± 10 years in the dapagliflozin group and 50 ± 10 in the control group. Common carotid artery, PSV, and EDV parameters were higher while RI was lower (p ˂ 0.01), in the dapagliflozin group than in the control group. Vascular resistance was lower in the group using dapagliflozin for diabetes management. In addition In the dapagliflozin group, the IMT decreased after dapagliflozin therapy (P < 0.01).

Conclusions

haemodynamic parameters were better performing in the group using dapagliflozin for diabetes management. Finally SGLT2i can decrease the IMT in patients with T2DM, which is closely related to cardiovascular benefit in patients with T2DM.

Deficiencies in health-related quality-of-life assessment and reporting: a systematic review of oncology randomized phase III trials published between 2012 and 2016

Quality of life (QoL) is a relevant end point and a topic of growing interest by both scientific community and regulatory authorities. Our aim was to review QoL prevalence as an end point in cancer phase III trials published in major journals and to evaluate QoL reporting deficiencies in terms of under-reporting and delay of publication. All issues published between 2012 and 2016 by 11 major journals were hand-searched for primary publications of phase III trials in adult patients with solid tumors. Information about end points was derived from paper and study protocol, when available. Secondary QoL publications were searched in PubMed. In total, 446 publications were eligible. In 210 (47.1%), QoL was not included among end points. QoL was not an end point in 40.1% of trials in the advanced/metastatic setting, 39.7% of profit trials and 53.6% of non-profit trials. Out of 231 primary publications of trials with QoL as secondary or exploratory end point, QoL results were available in 143 (61.9%). QoL results were absent in 37.6% of publications in the advanced/metastatic setting, in 37.1% of profit trials and 39.3% of non-profit trials. Proportion of trials not including QoL as end point or with missing QoL results was relevant in all tumor types and for all treatment types. Overall, 70 secondary QoL publications were found: for trials without QoL results in the primary publication, probability of secondary publication was 12.5%, 30.9% and 40.3% at 1, 2 and 3 years, respectively. Proportion of trials not reporting QoL results was similar in trials with positive results (36.5%) and with negative results (39.4%), but the probability of secondary publication was higher in positive trials. QoL is not included among end points in a relevant proportion of recently published phase III trials in solid tumors. In addition, QoL results are subject to significant under-reporting and delay in publication.

Performance of the Multidimensional Geriatric Assessment and Multidimensional Prognostic Index in predicting negative outcomes in older adults with cancer

The Multidimensional Geriatric Assessment (MGA) is currently used for assessing geriatric oncological patients, but a new prognostic index - the Multidimensional Prognostic Index (MPI) - has a demonstrated prognostic value in cancer patients too. The present work was designed to compare the MPI and MGA as predictors of 12-month mortality. 160 patients ≥70 years old with locally-advanced or metastatic solid cancers consecutively joining our Geriatric Oncology Program were administered a Comprehensive Geriatric Assessment to calculate their MGA and MPI scores.

SETTINGS

Geriatric Clinic, Geriatric Surgery Clinic, Medical Oncology Unit, Padova Hospital, Italy. Using Cohen's Kappa coefficient, there was a poor concordance between the MPI and MGA. Severe MPI being associated with a higher mortality risk than Frail in the MGA. The ROC curves indicated that the MPI had a greater discriminatory power for 12-month mortality than the MGA. In our population of elderly cancer patients, the MPI performed better than the MGA in predicting mortality. Further evidence from larger prospective trials is needed to establish whether other geriatric scales, such as the GDS and CIRS-SI, could enhance the value of prognostic indexes applied to elderly cancer patients.

Canadian Society of Transplantation Members' Views on Anonymity in Organ Donation and Transplantation

BACKGROUND

Anonymity has been central to medical, psychosocial, and societal practices in organ donation and transplantation. The purpose of this investigation was to explore transplant professionals' views on anonymity in the context of organ transplantation.

METHODS

The study consisted of an electronic 18-item survey distributed to the Canadian Society of Transplantation membership, asking about anonymity vs open communication/contact between organ recipients and donor families.

RESULTS

Of the 541 members surveyed, 106 replied. Among respondents, 71% felt that organ recipients and donor families should only communicate anonymously, yet 47% felt that identifying information could be included in correspondence between consenting recipients and donor families. When asked whether organ recipients and donor families should be allowed to meet, 53% of respondents agreed, 27% disagreed, and 20% neither agreed nor disagreed. With social media facilitating communication and eliminating the ability to maintain donor/recipient anonymity, 38% of respondents felt that a reexamination of current policies and practices pertaining to anonymity was necessary.

CONCLUSION

In conclusion, there was no dominant position on the issue of anonymity/communication between donor families and transplant recipients. Further research and discussion concerning the views of healthcare professionals, organ recipients, and donor families on the mandate of anonymity is needed and may influence future policy.

Monocytes of patients with amyotrophic lateral sclerosis linked to gene mutations display altered TDP-43 subcellular distribution

AIMS

Cytoplasmic accumulation of the nuclear protein transactive response DNA-binding protein 43 (TDP-43) is an early determinant of motor neuron degeneration in most amyotrophic lateral sclerosis (ALS) cases. We previously disclosed this accumulation in circulating lymphomonocytes (CLM) of ALS patients with mutant TARDBP, the TDP-43-coding gene, as well as of a healthy individual carrying the parental TARDBP mutation. Here, we investigate TDP-43 subcellular localization in CLM and in the constituent cells, lymphocytes and monocytes, of patients with various ALS-linked mutant genes.

METHODS

TDP-43 subcellular localization was analysed with western immunoblotting and immunocytofluorescence in CLM of healthy controls (n = 10), patients with mutant TARDBP (n = 4, 1 homozygous), valosin-containing protein (VCP; n = 2), fused in sarcoma/translocated in liposarcoma (FUS; n = 2), Cu/Zn superoxide dismutase 1 (SOD1; n = 6), chromosome 9 open reading frame 72 (C9ORF72; n = 4), without mutations (n = 5) and neurologically unaffected subjects with mutant TARDBP (n = 2).

RESULTS

TDP-43 cytoplasmic accumulation was found (P < 0.05 vs. controls) in CLM of patients with mutant TARDBP or VCP, but not FUS, in line with TDP-43 subcellular localization described for motor neurons of corresponding groups. Accumulation also characterized CLM of the healthy individuals with mutant TARDBP and of some patients with mutant SOD1 or C9ORF72. In 5 patients, belonging to categories described to carry TDP-43 mislocalization in motor neurons (3 C9ORF72, 1 TARDBP and 1 without mutations), TDP-43 cytoplasmic accumulation was not detected in CLM or in lymphocytes but was in monocytes.

CONCLUSIONS

In ALS forms characterized by TDP-43 mislocalization in motor neurons, monocytes display this alteration, even when not manifest in CLM. Monocytes may be used to support diagnosis, as well as to identify subjects at risk, of ALS and to develop/monitor targeted treatments.

The "one-out, all-out" principle entails the risk of imposing unnecessary restoration costs: a study case in two Mediterranean coastal lakes

The Water Framework Directive uses the "one-out, all-out" principle in assessing water bodies (i.e., the worst status of the elements used in the assessment determines the final status of the water body). In this study, we assessed the ecological status of two coastal lakes in Italy. Indices for all biological quality elements used in transitional waters from the Italian legislation and other European countries were employed and compared. Based on our analyses, the two lakes require restoration, despite the lush harbor seagrass beds, articulated macrobenthic communities and rich fish fauna. The "one-out, all-out" principle tends to inflate Type I errors, i.e., concludes that a water body is below the "good" status even if the water body actually has a "good" status. This may cause additional restoration costs where they are not necessarily needed. The results from this study strongly support the need for alternative approaches to the "one-out, all-out" principle.

Expert Recommendations for Managing Acute Faecal Incontinence with Diarrhoea in the Intensive Care Unit

Acute faecal incontinence with diarrhoea (AFId) has been reported to affect up to 40% of patients in the intensive care unit (ICU). The clinical challenges of AFId include the risk of perineal skin breakdown and cross-contamination with nosocomial infections, such as Clostridium difficile. In addition, the management of AFId is a burden on nursing time and hospital resources. Despite these challenges, there is currently no standard way of managing AFId. To address this problem, an international panel of intensive care specialists was convened to discuss AFId management recommendations. The collective knowledge of the specialists combined with literature searches from online medical databases were used to create a set of guidelines together with an accompanying management algorithm to aid healthcare providers in deciding the most appropriate care for patients with AFId in the ICU. These guidelines have been specifically designed to take into account patient severity of illness and comorbidities, which coupled with common AFId-associated clinical complications, can influence management choices. A comprehensive review of current AFId management strategies, taking into account the spectrum of patients and hospital economic limitations, has been included as a reference guide. It is hoped that the wider adoption of these recommendations will be a step forward in improving the current management of AFId in the ICU.

Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature

BACKGROUND

Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there are few long-term follow-up and functional outcome data available. Using meta-analysis techniques, this study was designed to evaluate long-term results of open and laparoscopic abdominal procedures to treat full-thickness rectal prolapse in adults.

METHODS

A literature review was performed using the National Library of Medicine's PubMed database. All articles on abdominal rectopexy patients with a follow-up longer than 16 months were considered. The primary end point was recurrence of rectal prolapse, and the secondary end points were improvement in incontinence and constipation. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed.

RESULTS

Eight comparative studies, consisting of a total of 467 patients (275 open and 192 laparoscopic), were included. Analysis of the data suggested that there is no significant difference in recurrence, incontinence and constipation improvement between laparoscopic abdominal rectopexy and open abdominal rectopexy. Considering non-comparative trials, the event rate for recurrence was similar in open and laparoscopic suture rectopexy studies and in open and laparoscopic mesh rectopexy trials. Improvement in constipation after the intervention was not statistically significant except for open mesh repair; postoperative improvement in incontinence was statistically significant after laparoscopic procedures and open mesh rectopexy.

CONCLUSIONS

Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regard to recurrence, incontinence and constipation. However, large-scale randomized trials, with comparative, strong methodology, are still needed to identify outcome measures accurately.

The obligation to say 'Thank you': heart transplant recipients' experience of writing to the donor family

Transplant recipients are encouraged to write anonymous thank-you letters to the donor family. We prospectively explored heart transplant recipients' embodied responses to the 'obligation' to write a thank-you letter using audio/video-taped open-ended interviews (N = 27). Fifteen of the 19 participants, who wrote letters to the donor family, expressed or visually revealed significant distress about issues such as the obligation to write anonymously and the inadequacy of the 'thank-you'. Writing the thank-you letter is not a neutral experience for heart transplant recipients. Rethinking the obligatory practice regarding the thank-you letter and developing the necessary support for the recipient through this process is necessary.

Sympathectomy alters bone architecture in adult growing rats

Sympathetic nervous system (SNS) fibres and alpha- and beta-receptors are present in bone, indicating that the SNS may participate in bone metabolism. The importance of these observations is controversial because stimulation or inhibition of the SNS has had various effects upon both anabolic and catabolic activity in this tissue. In this study we evaluated the effects of pharmacological sympathectomy, using chronic treatment of maturing male rats with 40 mg of guanethidine/kg i.p., upon various parameters in bone. Double labelling with tetracycline injection was also performed 20 and 2 days before sacrifice. Bone mass, mineral content, density and histomorphometric characteristics in different skeletal regions were determined. Bone metabolic markers included urinary deoxypyridinoline and serum osteocalcin measurements. Guanethidine significantly reduced the accretion of lumbar vertebral bone and of mineral content and density, compared to controls. Femoral bone mineral content and density were also significantly reduced, compared to controls. Histomorphometric analyses indicated these effects were related to a reduction of cortical bone and mineral apposition rate at femoral diaphysials level. Both markers of bone metabolism were reduced in controls as they approached maturity. Guanethidine significantly decreased serum osteocalcin compared to controls, while urinary deoxypyridinoline was unchanged. These data indicate that guanethidine-induced sympathectomy caused a negative balance of bone metabolism, leading to decreased mass by regulating deposition rather than resorption during modeling and remodeling of bone.

Air pollution impact assessment on agroecosystem and human health characterisation in the area surrounding the industrial settlement of Milazzo (Italy): a multidisciplinary approach

In order to evaluate the impact of atmospheric pollutants emitted by the industrial settlement of Milazzo (Italy) on agriculture, sulphur dioxide and ozone levels in air were monitored and the data were used to estimate yield losses of the most widespread cultures. Trace element concentrations in crops and soils were also detected and metabolic profiles of soil microbial communities were considered. Vibrio fischeri test was used to appraise airborne pollutant ecotoxicity and epidemiological studies on causes of death distribution were carried out to characterize health state of people living in the area. All the sampling points were selected in farms on the basis of a theoretical meteo-diffusive model of industrial air pollutants. Experimental SO2 and O3 values mainly exceeded the threshold established by Italian and EU regulations to protect vegetation and they correspond to estimated significant crop losses. Conversely toxic element residues in soils and in agroalimentary products were generally lower than the fixed values. SO2 and O3 concentrations, toxic element contents and ecotoxicity levels of airborne pollutants were not related only to industrial site emissions, while the fluctuations on metabolic profiles of soil microbial communities seem to agree with the predicted deposition of xenobiotic compounds from the industrial plants. The epidemiological study evidenced a better health state of populations living in the investigated area than in the Messina province and the Sicily region but, inside the area, males living in the municipalities closest to the industrial settlement exhibited a worst health state than those in the very far ones.

Antimicrobial activity of a nisin-activated plastic film for food packaging

AIMS

To determine the effectiveness of a packaging film coated with nisin to inhibit Micrococcus luteus ATCC 10240 in tryptone soya broth (TSB) and the microbiota of raw milk during storage. A further aim was to examine the release of nisin from the activated film.

METHODS AND RESULTS

An active package, obtained from nisin-treated film, was filled with 1 l of M. luteus ATCC 10240 (ML) suspension in TSB and stored at 4 and 25 degrees C for 2 days. After 24 h at 25 degrees C there was a remarkable reduction of M. luteus ATCC 10240 compared with the control, while at 4 degrees C a slight reduction was observed. Moreover, microbial growth was controlled when 1 l of three different kinds of milk was poured into the active package and stored at 4 degrees C for 7 days. The most significant results were observed in raw milk and pasteurized milk with a reduction of 0.9 log and 1.3 log, respectively. The release experiments showed that nisin release from the film was unpredictable, but it was favoured by low pH and high temperature.

CONCLUSIONS

It appears that nisin-coated films were effective in inhibiting M. luteus ATCC 10240 in TSB and the bacterial flora in milk, and the release of nisin was pH and temperature dependent.

SIGNIFICANCE AND IMPACT OF THE STUDY

Nisin-activated film may control bacterial growth, maintaining food quality, safety and extending the shelf-life of food products.

Using remifentanil and sufentanil in functional endoscopic sinus surgery to improve surgical conditions

The purpose of the study was to compare three types of general anesthesia for functional endoscopic sinus surgery (ESS) with controlled hypotension measuring the quality of visibility of the surgical field and the blood loss during the operation. Seventy-one patients underwent endoscopic ethmoidectomy bilaterally for nasal polyposis and/or chronic sinusitis. The patients were divided into three groups according to the type of anesthesia they had: group A (sufentanil/sevoflurane), group B (remifentanil/propofol), and group C (fentanyl/isoflurane). The mean estimated blood loss for group A was 117.83 ml, for group B it was 100.5 ml and for group C it was 198.89 ml. The average quality of visibility of the surgical field was 1.57 for group A, 1.3 for group B and 2.79 for group C. The quantity of blood loss (p < 0.01) and the visibility of the surgical field (p < 0.001) demonstrated a difference among the three groups. Remifentanil and sufentanil during functional ESS enable controlled hypotension and a general improvement in surgical conditions.

Assignment of the complete disulphide bridge pattern in the human recombinant follitropin beta-chain

The chemical assessment of the complete disulphide bridge pattern in the beta-chain of human recombinant follicotropin (betaFSH) was accomplished by integrating classical biochemical methodologies with mass spectrometric procedures. A proteolytic strategy consisting of a double digestion of native betaFSH using the broad-specificity protease subtilisin first, followed by trypsin, was employed. The resulting peptide mixture was directly analysed by FAB-MS, leading to the assignment of the first three disulphide bridges. The remaining S-S bridges were determined by HPLC fractionation of the proteolytic digest followed by ESMS analysis of the individual fractions. The pattern of cysteine couplings in betaFSH was determined as: Cys3-Cys5l, Cys17-Cys66, Cys20-Cys104, Cys28-Cys82, Cys32-Cys84 and Cys87-Cys94, confirming the arrangement inferred from the crystal structure of the homologous betaCG. A subset of the S-S bridge pattern comprising Cys3-Cys51, Cys28-Cys82 and Cys32-Cys84 constitutes a cysteine knot motif similar to that found in the growth factor superfamily.

Structural analysis of modified forms of recombinant IFN-beta produced under stress-simulating conditions

The present study focused on the investigation of the chemical stability of recombinant human interferon-beta (rhIFN-beta) tested in vitro by chemical treatments that simulate stress-induced conditions that may occur during handling, storage or ageing of protein samples. Mild oxidation and/or alkylation of the recombinant protein showed that the four methionines occurring in the interferon displayed different chemical susceptibility in that Met36 and Met117 were fully modified, whereas Met1 showed only little modification and Met62 was completely resistant. Moreover, incubation of rhIFN-beta under alkaline conditions resulted in the formation of a covalent dimeric species stabilised by an intermolecular disulphide bridge involving the free SH group of Cys17 from each polypeptide chain. Analysis of biological activity of the different IFN-beta derivatives showed that rhIFN-beta fully retains its specific activity following mild oxidation treatments whereas reaction with a high concentration of alkylating agents or incubation under alkaline conditions strongly reduce its specific antiviral activity.

Learning of interpolation in 2 and 3 dimensions

We investigated learning of spatio-temporal interpolation in depth and its relation to spatio-temporal interpolation in two dimensions by means of a vernier discrimination task. Performance improved with training but improvement did not or only partially transfer between opposite directions of motion in depth. Improvement was also at least partly specific for the eye and for the direction of two-dimensional motion used during monocular training. This specificity might explain the apparent specificity of interpolation in three dimensions. Training with stimuli moving in two dimensions increased performance for a stimulus moving in depth. The results indicate that improvement in spatio-temporal interpolation occurs at least partly on a stage preceding stereoscopic vision, and are a rare example for transfer of improvement between different perceptual tasks.

Structural characterisation of human recombinant glycohormones follitropin, lutropin and choriogonadotropin expressed in Chinese hamster ovary cells

The alpha and beta chains from human recombinant gonadotropins follitropin, lutropin and choriogonadotropin expressed in CHO cells have been structurally characterised both at the protein and at the carbohydrate level by using advanced mass spectrometric procedures. The three alpha chains share the same amino acid sequence while they display different glycosylation patterns. The oligosaccharide structures detected belong to the complex-type glycans with different degree of sialylation. Partial proteolytic processing occurred at the N-terminus of the follitropin beta chain and at the C-terminus of the lutropin beta chain. The N-linked glycans from the three beta chains were found to contain fucosylated and sialylated diantennary and triantennary complex-type structures. The follitropin beta chain showed the presence of N-acetyllactosamine repeats on the antennae. The overall structure of the recombinant glycohormones corresponds to their natural counterparts with the exception that sulphated terminal glycosylation is missing.

Lysine acetylsalicylate modifies aphagia and thermogenic changes induced by lateral hypothalamic lesion

These experiments test the effect of intraperitoneal injection of lysine acetylsalicylate on 1) food intake and 2) the sympathetic and thermogenic changes induced by lesion of the lateral hypothalamus (LH). Food intake, firing rate of the nerves innervating interscapular brown adipose tissue (IBAT), and IBAT and colonic temperatures (TIBAT and TC) were monitored in male Sprague-Dawley rats lesioned in the LH. These variables were measured before and after intraperitoneal injection of lysine acetylsalicylate. The same variables were also monitored in 1) lesioned rats with intraperitoneal administration of saline, 2) sham-lesioned animals with intraperitoneal injection of lysine acetylsalicylate, and 3) sham-lesioned rats with intraperitoneal injection of saline. The results show that lysine acetylsalicylate modifies the aphagia by increasing food intake and also reduces the enhancements in firing rate, TIBAT, and TC induced by LH lesion. These findings suggest that prostaglandin synthesis plays a key role in the control of eating behavior in LH-lesioned rats by acting on the sympathetic and thermogenic changes induced by LH lesion.

[The use of osteointegrated implants in plastic surgery. Ear reconstruction]

The authors present the case of a 14-year-old patient suffering from first branchial arch syndrome with agenesia of the auricle in which the auricle was reconstructed using osteointegrated implants. The patient had previously undergone numerous attempts at reconstruction using traditional methods, all of which had failed. In order to ensure an accurate preoperative evaluation, the patient was studied using CT with a standard technique and three-dimensional image reconstruction for a qualitative and quantitative evaluation of bone thickness so as to allow the optimal positioning of fixtures. This test also revealed the existence and good degree of development of the middle and internal ear. The Authors then proceeded to implant 4 titanium fixtures into the mastoid process of the temporal bone, three of which were used for fixing the auricle prosthesis and one for the insertion of a bone anchored hearing aid. The epithesis, in soft silicon, was modelled to match the contralateral ear with excellent aesthetic results.

NG methyl-L-arginine increases the hyperthermic effects of prostaglandin E1

The sympathetic firing rate of the nerves innervating interscapular brown adipose tissue (IBAT), IBAT and colonic temperatures (TIBAT and TC) were monitored in urethane-anaesthetized male Sprague-Dawley rats. These variables were measured for a period of 40 min before (baseline values) and 40 min after a 2 mg NG-methyl-L-arginine (NMA) injection plus an intracerebroventricular administration of 500 ng prostaglandin E1 (PGE1) into a lateral cerebral ventricle. No drug was injected in control rats. The results show that NMA enhances the increases in firing rate, TIBAT and TC induced by PGE1. These findings indicate that an inhibitor of nitric oxide synthesis, such as NMA, increases the sympathetic and thermogenic responses to injection of PGE1.

Spatio-temporal interpolation in depth

Spatio-temporal interpolation creates the impression of motion from a rapid sequence of stationary images by reconstructing the motion path in between the stations actually presented. Thresholds below the diameter of foveal photoreceptors have been obtained with two-dimensional spatio-temporal interpolation. We found that also three-dimensional interpolation, i.e. interpolation in depth, where information from motion detectors tuned to opposite directions in both eyes has to be combined, yields thresholds in the hyperacuity range. The results of parametric experiments favour the interpretation that interpolation occurs at a monocular stage of visual processing, rather than on a stereoscopic stage.