Salivary proteomic profile of young healthy subjects

Background: The incidence of noncommunicable diseases (NCDs) has been rapidly ramped up worldwide. Hence, there is an urgent need to non-invasively detect NCDs possibly by exploiting saliva as a 'liquid biopsy' to identify biomarkers of the health status. Since, the absence of standardized procedures of collection/analysis and the lack of normal ranges makes the use of saliva still tricky, our purpose was to outline a salivary proteomic profile which features healthy individuals. Methods: We collected saliva samples from 19 young blood donors as reference population and the proteomic profile was investigated through mass-spectrometry. Results: We identified 1,004 proteins of whose 243 proteins were shared by all subjects. By applying a data clustering approach, we found a set of six most representative proteins across all subjects including Coronin-1A, F-actin-capping protein subunit alpha, Immunoglobulin J chain, Prosaposin, 78 kDa glucose-regulated protein and Heat shock 70 kDa protein 1A and 1B. Conclusion: All of these proteins are involved in immune system activation, cellular stress responses, proliferation, and invasion thus suggesting their use as biomarkers in patients with NCDs.

Artificial neural networks allow response prediction in squamous cell carcinoma of the scalp treated with radiotherapy

BACKGROUND

Epithelial neoplasms of the scalp account for approximately 2% of all skin cancers and for about 10-20% of the tumours affecting the head and neck area. Radiotherapy is suggested for localized cutaneous squamous cell carcinomas (cSCC) without lymph node involvement, multiple or extensive lesions, for patients refusing surgery, for patients with a poor general medical status, as adjuvant for incompletely excised lesions and/or as a palliative treatment. To date, prognostic risk factors in scalp cSCC patients are poorly characterized.

OBJECTIVE

To identify patterns of patients with higher risk of postradiotherapy recurrence.

METHODS

A retrospective observational study was performed on scalp cSCC patients with histological diagnosis who underwent conventional radiotherapy (50-120 kV) (between 1996 and 2008, follow-up from 1 to 140 months, median 14 months). Out of the 79 enrolled patients, 22 (27.8%) had previously undergone a surgery. Two months after radiotherapy, 66 (83.5%) patients achieved a complete remission, 6 (7.6%) a partial remission, whereas 2 (2.5%) proved non-responsive to the treatment and 5 cases were lost to follow-up. Demographical and clinical data were preliminarily analysed with classical descriptive statistics and with principal component analysis. All data were then re-evaluated with a machine learning-based approach using a 4th generation artificial neural networks (ANNs)-based algorithm.

RESULTS

Artificial neural networks analysis revealed four scalp cSCC profiles among radiotherapy responsive patients, not previously described: namely, (i) stage T2 cSCC type, aged 70-80 years; (ii) frontal cSCC type, aged <70 years; (iii) non-recurrent nodular or nodulo-ulcerated, stage T3 cSCC type, of the vertex and treated with >60 Grays (Gy); and (iv) flat, occipital, stage T1 cSCC type, treated with 50-59 Gy. The model uncovering these four predictive profiles displayed 85.7% sensitivity, 97.6% specificity and 91.7% overall accuracy.

CONCLUSIONS

Patient profiling/phenotyping with machine learning may be a new, helpful method to stratify patients with scalp cSCCs who may benefit from a RT-treatment.

Maternal estradiol and progesterone concentrations among singleton spontaneous pregnancies during the first trimester

BACKGROUND

Pregnancy hormonal milieu represents a crucial determinant of fetal outcome. We aim to determine 17β-estradiol (E₂) and progesterone (PGT) concentrations in spontaneous pregnancies during the first trimester. In addition, we aim to determine E₂ concentrations as a function of gestational age (GA) and PGT.

METHODS

Between November 2015 and March 2017, 104 healthy women of at least 18 years undergoing medical consultation for voluntary interruption of pregnancy were enrolled in an observational study at University Hospital ASST Fatebenefratelli Sacco, Milan, Italy. Only singleton pregnancies between 5⁺⁰ and 13⁺⁶ weeks of gestation were eligible. First trimester ultrasound scans were performed for dating and one fasting venous blood sample was collected for E₂ and PGT determinations.

RESULTS

E₂ and PGT concentrations steadily increased according to GA. The correlation between E₂ on a logarithmic scale and PGT concentrations was expressed by the following equation, explaining 12.6% of E₂ variance: logE₂ = 2.57 + 0.1 × PGT, (r = 0.34, p < 0.001). By performing a multivariable linear regression analysis adjusted for variables significantly correlated with E₂ concentrations, we obtained a model explaining the 53.5% of E₂ variance. The final equation to determine E₂ concentrations among Caucasian women was: logE₂ = 1.96 + 0.01 × GA + 0.004 × PGT.

CONCLUSIONS

Gestational week-specific reference intervals are reported for maternal E₂ and PGT concentrations during early pregnancy, further providing a model for E₂ assessment in this period. This will represent a starting point for further evaluations between twin and ART pregnancies, as well as to potentially improve pregnancy outcome and future health of the offspring.

Pregnancy risk factors related to autism: an Italian case-control study in mothers of children with autism spectrum disorders (ASD), their siblings and of typically developing children

This study, carried out in two Italian Institutions, assesses the frequency of 27 potential autism risk factors related to pregnancy and peri- and postnatal periods by interviewing mothers who had children with autism, children with autism and one or two typically developing siblings, or only typically developing children. The clinical sample included three case groups: 73 children and adolescents with autism (Group A), 35 children and adolescents with autism (Group A1) having 45 siblings (Group B) and 96 typically developing children (Group C) matched for gender and age. Twenty-five out of 27 of risk factors presented a higher frequency in Group A in comparison with Group C and for nine of them a statistically significant difference was found. Twenty-one out of 27 of risk factors presented a higher frequency in Group A in comparison with Group B. A higher prevalence of environmental risk factors was observed in 11 risk factors in the Group A1 in comparison with Group B and for nine of them an odds ratio higher than 1.5 was found. For 13 factors there was a progressive increase in frequency going from Group C, B and A and a statistically higher prevalence of the mean number of stressful events per pregnancy was recorded in Group A when compared with Groups B and C. The results suggest that environmental, incidental phenomena and stressful life events can influence pregnancy outcome in predisposed subjects, pointing out a possible threshold effect in women who are predisposed to have suboptimal pregnancies.

Plasma fatty acid profile as biomarker of coronary artery disease: a pilot study using fourth generation artificial neural networks

Many studies, focused on identifying new biomarkers for coronary artery disease (CAD) risk computation and monitoring, suggested a potential diagnostic role for fatty acids (FA). In the present study, we explored the potential diagnostic role of FA by using a data mining approach based on fourth generation artificial neural networks (ANN). Forty-one male subjects were enrolled. According to coronary angiography, 31 displayed CAD and 10 did not (non-CAD, control group). FA analysis was performed on plasma samples using a gas chromatography-mass spectrometry system and analyses were performed by an ANN method. The variables most closely related to CAD were low levels of alpha-linolenic acid, eicosapentaenoic acid, eicosatetraenoic and docosahexaenoic acids. High levels of 1,1-dimethoxyhexadecane, total dimethyl acetals and docosatetraenoic acid were related to non-CAD condition. This subset of variables, which were most closely correlated to the target diagnosis, achieved a consistent predictive rate. The average accuracy obtained was 76.5%, with 93% of sensitivity and 60% of specificity. The area under the ROC curve was equal to 0.79. In conclusion, our study highlighted the association between different plasma FA species, CAD and non-CAD conditions. The specific subset of variables could be of interest as a new diagnostic tool for CAD management.

Association between coffee or tea drinking and Barrett's esophagus or esophagitis: an Italian study

BACKGROUND/OBJECTIVES

Only a few papers have treated of the relationship between Barrett's esophagus (BE) or erosive esophagitis (E) and coffee or tea intake. We evaluated the role of these beverages in BE and E occurrence.

SUBJECTS/METHODS

Patients with BE (339), E (462) and controls (619) were recruited. Data on coffee and tea and other individual characteristics were collected using a structured questionnaire.

RESULTS

BE risk was higher in former coffee drinkers, irrespective of levels of exposure (cup per day; ⩽1: OR=3.76, 95% CI 1.33-10.6; >1: OR=3.79, 95% CI 1.31-11.0; test for linear trend (TLT) P=0.006) and was higher with duration (>30 years: OR=4.18, 95% CI 1.43-12.3; TLT P=0.004) and for late quitters, respectively (⩽3 years from cessation: OR=5.95, 95% CI 2.19-16.2; TLT P<0.001). The risk of BE was also higher in subjects who started drinking coffee later (age >18 years: OR=6.10, 95% CI 2.15-17.3). No association was found in current drinkers, but for an increased risk of E in light drinkers (<1 cup per day OR =1.85, 95% CI 1.00-3.43).A discernible risk reduction of E (about 20%, not significant) and BE (about 30%, P<0.05) was observed in tea drinkers.

CONCLUSIONS

Our data were suggestive of a reduced risk of BE and E with tea intake. An adverse effect of coffee was found among BE patients who had stopped drinking coffee. Coffee or tea intakes could be indicative of other lifestyle habits with protective or adverse impact on esophageal mucosa.

Prediction of high on-treatment platelet reactivity in clopidogrel-treated patients with acute coronary syndromes

BACKGROUND

About 40% of clopidogrel-treated patients display high platelet reactivity (HPR). Alternative treatments of HPR patients, identified by platelet function tests, failed to improve their clinical outcomes in large randomized clinical trials. A more appealing alternative would be to identify HPR patients a priori, based on the presence/absence of demographic, clinical and genetic factors that affect PR. Due to the complexity and multiplicity of these factors, traditional statistical methods (TSMs) fail to identify a priori HPR patients accurately. The objective was to test whether Artificial Neural Networks (ANNs) or other Machine Learning Systems (MLSs), which use algorithms to extract model-like 'structure' information from a given set of data, accurately predict platelet reactivity (PR) in clopidogrel-treated patients.

METHODS

A complete set of fifty-nine demographic, clinical, genetic data was available of 603 patients with acute coronary syndromes enrolled in the prospective GEPRESS study, which showed that HPR after 1month of clopidogrel treatment independently predicted adverse cardiovascular events in patients with Syntax Score >14. Data were analysed by MLSs and TSMs. ANNs identified more variables associated PR at 1month, compared to TSMs.

RESULTS

ANNs overall accuracy in predicting PR, although superior to other MLSs was 63% (95% CI 59-66). PR phenotype changed in both directions in 35% of patients across the 3 time points tested (before PCI, at hospital discharge and at 1month).

CONCLUSIONS

Despite their ability to analyse very complex non-linear phenomena, ANNs or MLS were unable to predict PR accurately, likely because PR is a highly unstable phenotype.

Inequalities in access to biological treatments for psoriasis: results from the Italian Psocare registry

BACKGROUND

Limited evidence is available on the impact of socioeconomic factors on drug prescriptions for psoriasis.

OBJECTIVES

To investigate factors influencing prescription of conventional vs. biological treatment for patients with psoriasis, based on the Italian Psocare registry, with a special focus on socioeconomic factors.

METHODS

This was a cross-sectional study evaluating the baseline data of patients included in the Psocare registry. All of the consecutive adult patients with a diagnosis of chronic plaque psoriasis or psoriatic arthritis who were prescribed a systemic treatment for psoriasis at participating centres were included in this study. Univariate and multivariate analyses of the baseline factors associated with a biologics prescription were performed.

RESULTS

From September 2005 to September 2009, 12 838 patients were identified. A multivariate analysis revealed that, among other factors, completing a level of education higher than lower secondary school and being employed as a manager or a professional were independent factors associated with a biologics prescription at entry in the registry. Additional analyses on the association between these two variables and a severe psoriasis condition [Psoriasis Area Severity Index (PASI) score > 20] revealed a significantly increasing trend of severe disease towards lower educational attainment, while unemployed patients were more likely to have a more severe condition compared with the other categories of workers.

CONCLUSIONS

We documented inequalities of drug prescriptions for psoriasis in Italy, with a trend towards a higher frequency of prescription for more expensive biologics in higher socioeconomic sectors of the population.

The constellation of dietary factors in adolescent acne: a semantic connectivity map approach

BACKGROUND

Different lifestyle and dietetic factors have been linked with the onset and severity of acne.

OBJECTIVE

To assess the complex interconnection between dietetic variables and acne.

METHODS

This was a reanalysis of data from a case-control study by using a semantic connectivity map approach. 563 subjects, aged 10-24 years, involved in a case-control study of acne between March 2009 and February 2010, were considered in this study. The analysis evaluated the link between a moderate to severe acne and anthropometric variables, family history and dietetic factors. Analyses were conducted by relying on an artificial adaptive system, the Auto Semantic Connectivity Map (AutoCM).

RESULTS

The AutoCM map showed that moderate-severe acne was closely associated with family history of acne in first degree relatives, obesity (BMI ≥ 30), and high consumption of milk, in particular skim milk, cheese/yogurt, sweets/cakes, chocolate, and a low consumption of fish, and limited intake of fruits/vegetables.

CONCLUSION

Our analyses confirm the link between several dietetic items and acne. When providing care, dermatologists should also be aware of the complex interconnection between dietetic factors and acne.

Mindfulness trait, eating behaviours and body uneasiness: a case-control study of binge eating disorder

BACKGROUND

Binge eating disorder (BED) is a complex and multifaceted eating disorder, and the literature indicates that BED patients show greater difficulty in identifying and making sense of emotional states, and that they have limited access to emotion regulation strategies. Findings show many links between mindfulness and emotional regulation, however there has been no previous research on mindfulness traits in BED patients.

METHOD

One hundred fifty BED patients (N=150: women=98, men=52; age 49.3±4.1) were matched for gender, age, marital status and educational level with 150 non-bingeing obese and 150 normal-weight subjects. All were assessed with the Five Facet Mindfulness Questionnaire (FFMQ), Binge Eating Scale (BES), Objective bulimic episodes (EDE-OBEs) and Body Uneasiness Test (BUT). For all the participants past or current meditation experience was an exclusion criteria.

RESULTS

Findings showed that Mindfulness-global, Non reactivity to experience, Acting with awareness, Describing with words and Observation of experience scores were significantly lower in BED than control groups (p<0.05). However, on the mindfulness measures, the obese control group did not differ from the normal weight control group. Moreover, correlations showed that mindfulness was more widely negatively correlated with the BED's OBEs, BES and BUT-GSI scores. Meanwhile, binge eating behaviours, frequency and severity (OBEs and BES) were more negatively correlated with action (Nonreactivity- to-experience and Acting-with-awareness scores). Body Uneasiness was more negatively correlated with mental processes (Describing-with-words and Observation-ofexperience) and mindfulness features.

CONCLUSION

Implications on understanding of the mechanisms underlying the development and maintenance of problematic eating in BED were considered. Moreover, clinical considerations on treatment targets of mindfulnessbased eating awareness training were discussed.

LDL oxidative modification and carotid atherosclerosis: results of a multicenter study

OBJECTIVE

Serum LDL conjugated diene concentration is a marker of oxidative modification of LDL. We investigated the relationship between LDL conjugated dienes and cross-sectional subclinical atherosclerosis assessed by carotid IMT in high-risk subjects of a multicenter study.

METHODS

Serum LDL conjugated dienes and ultrasonographically assessed carotid intima-media thickness (IMT(mean), IMT(max) and IMT(mean-max)) were available for 553 subjects from Finland, France, Italy, the Netherlands, and Sweden.

RESULTS

In multivariate regression analysis, gender (p < 0.001), age (p < 0.001), systolic blood pressure (IMT(mean), p = 0.01; IMT(mean-max), p = 0.05) and serum LDL conjugated dienes (p = 0.02 for both IMT(mean) and IMT(mean-max)) were the strongest determinants of IMT variation, adjusted for study center, ultrasound videotape reader and serum LDL cholesterol. Pack-years of smoking, added into the regression model, did not destroy the significant association between increased serum LDL conjugated dienes and IMT. Ratio of LDL conjugated dienes to LDL particle cholesterol was higher in subjects of Northern recruiting centers than of Southern centers (r = 0.39, p < 0.0001).

CONCLUSIONS

There was a cross-sectional association between in vivo increased LDL oxidative modification and subclinical atherosclerosis after adjustment for traditional risk factors. The subjects in Northern countries of Europe had more oxidatively modified lipids per cholesterol in LDL particle than subjects in Southern countries.

Ten years survival of FIGO stage IIIC epithelial ovarian cancer cases due to lymph node metastases only

PURPOSE OF INVESTIGATION

In this paper the authors have analyzed the long-term survival of women with Stage III ovarian cancer due to lymph node metastasis.

MATERIALS AND METHODS

This retrospective study included 27 patients with FIGO Stage IIIC epithelial ovarian carcinoma due to lymph node metastases observed consecutively at the Mangiagalli Clinic of Milan from 1982 to 2008.

RESULTS

Two cases had Fallopian tube carcinoma. A total of ten recurrences were observed. Median time to recurrence was 158 months. The five-year disease-free survival (DFS) was 57.7%. The ten-year corresponding value was 53.2%. Median survival time was 158 months, with median follow-up time of 169 months. The five-year (overall survival) OS rate was 77.1%; the ten-year rate was 55.4%.

CONCLUSION

Women with ovarian cancer Stage IIIC due to nodal involvement have a five-year OS of about 80% and a ten-year OS of about 50%.

A systems biology approach: new insights into fetal growth restriction using Bayesian Networks

IL-6, IGF-II and IGFBP-2 concentrations in placental lysates were previously shown to be associated with foetal growth. This study aimed to apply a Bayesian Network (BN) model in order to investigate complex dependencies among biochemical and clinical factors and fetal growth outcome. Twenty-one Intra-Uterine Growth Restricted (IUGR) and 25 Appropriate for Gestational Age (AGA) pregnancies were followed throughout pregnancy. Information was collected on maternal and gestational age, neonatal gender, previous gynaecological history. Total protein content, IGF-II, IGFBP-1, IGFBP-2, IL-6, and TNF-alpha concentrations in placental lysates were measured, and IGF-I, IGF-II, IGFBP-1, IGFBP-2 and IL-6 relative gene expression in placenta assessed. A BN and a hybrid forecasting system were implemented: BN revealed a key role of maternal age and TNF-alpha on IUGR and confirmed a close relationship among IGF-II, IL-6 and foetal growth. A relationship between duration of gestation, appropriateness for gestational age, and placental IL-6 concentration was also confirmed. Compared with other techniques, BN showed a better accuracy. Findings confirmed a major role of maternal age in addition to IGF-II, IL-6 and TNF-alpha in IUGR. A direct role of IGFBP-2 was not shown. BN confirmed to be useful in understanding the system's biology and graphically representing variable relationships and hierarchy, particularly where, as in IUGR, many interactions among predictors exist.

How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre?

BACKGROUND

Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres.

METHODS

A post-hoc analysis of two multicentre cross-sectional studies, including 6270 and 8252 patients consecutively referred to EGD in 44 (group A) and 55 (group B) endoscopic Italian centres in 2003 and 2007, respectively, was performed. A multiple forward stepwise regression was applied to group A, and independently validated in group B. A <70% threshold was adopted to define inadequate appropriateness rate clustered by centre.

RESULTS

discrete variability of clustered appropriateness rates among the 44 group A centres was observed (median: 77%; range: 41-97%), and a <70% appropriateness rate was detected in 11 (25%). Independent predictors of centre appropriateness rate were: percentage of patients referred by general practitioners (GP), rate of urgent examinations, prevalence of relevant diseases, and academic status. For group B, sensitivity, specificity and area under receiver operating characteristic curve of the model in detecting centres with a <70% appropriateness rate were 54%, 93% and 0.72, respectively.

CONCLUSIONS

A simple predictive rule, based on rate of patients referred by GPs, rate of urgent examinations, prevalence of relevant diseases and academic status, identified a small subset of centres characterised by a high rate of inappropriateness. These centres may be presumed to obtain the largest benefit from targeted educational programs.

The I.F.A.S.T. model allows the prediction of conversion to Alzheimer disease in patients with mild cognitive impairment with high degree of accuracy

This paper presents the results obtained with the innovative use of special types of artificial neural networks (ANNs) assembled in a novel methodology named IFAST (implicit function as squashing time) capable of compressing the temporal sequence of electroencephalographic (EEG) data into spatial invariants. The aim of this study is to test the potential of this parallel and nonlinear EEG analysis technique in providing an automatic classification of mild cognitive impairment (MCI) subjects who will convert to Alzheimer's disease (AD) with a high degree of accuracy. Eyes-closed resting EEG data (10-20 electrode montage) were recorded in 143 amnesic MCI subjects. Based on 1-year follow up, the subjects were retrospectively classified to MCI converted to AD and MCI stable. The EEG tracks were successively filtered according to four different frequency ranges, in order to evaluate the hypotheses that a specific range, corresponding to specific brain wave type, could provide a better classification (0.12 Hz, 12.2 - 29.8 Hz; 30.2 - 40 Hz, and finally Notch Filter 48 - 50 Hz). The spatial content of the EEG voltage was extracted by IFAST step-wise procedure using ANNs. The data input for the classification operated by ANNs were not the EEG data, but the connections weights of a nonlinear auto-associative ANN trained to reproduce the recorded EEG tracks. These weights represented a good model of the peculiar spatial features of the EEG patterns at scalp surface. The classification based on these parameters was binary and performed by a supervised ANN. The best results distinguishing between MCI stable and MCI/AD reached to 85.98%.(012 Hz band). And confirmed the working hypothesis that a correct automatic classification can be obtained extracting spatial information content of the resting EEG voltage by ANNs and represent the basis for research aimed at integrating spatial and temporal information content of the EEG. These results suggest that this low-cost procedure can reliably distinguish eyes-closed resting EEG data in individual MCI subjects who will have different prognosis at 1-year follow up, and is promising for a large-scale periodic screening of large populations at amnesic MCI subjects at risk of AD.

Gene-gene and gene - clinical factors interaction in acute myocardial infarction: a new detailed risk chart

AIMS

The complex pathogenesis of acute myocardial infarction (AMI) implicates phenotypic and genetic heterogeneity. In this pilot case-control study single nucleotide polymorphism (SNP) in several inflammatory genes, such as interleukin (IL)-1beta, IL-6, IL-10, alpha-1-antichymotrypsin (ACT), tumor necrosis factor alpha (TNF)-alpha and interferon gamma (IFN)-gamma genes along with SNPs of genes regulating vascular functions (vascular endothelial growth factor; VEGF) and cholesterol synthesis (hydroxy-methyl-glutaryl CoA reductase; HMGCR) were investigated.

METHODS

Patients were genotyped with RT-PCR technique and data were analyzed with a new mathematical algorithm named Auto Contractive Map.

RESULTS

The Auto Contractive Map (AutoCM), was applied in AMI patients with the aim to detect and evaluate the relationships among genetic factors, clinical variables and classical risk factors. Genes were selected because their strong regulatory effect on inflammation and SNP in these gene were located in the promoter region. In the connectivity map generated by AutoCM a group of variables was directly linked with the AMI status; these were: gender (male), early age at onset (50-65 years), HMGCR gene (CC wild type genotype), IL-1betaCT, IL-6 GG and VEGF CC genotypes. This direct link suggested a possible pathogenetic association with AMI. Other genetic, clinical and phenotypic variables were associated to the disease under a statistically defined hierarchy showed in the new connectivity map generated by AutoCM.

CONCLUSION

These analyses suggested that genotypes of few inflammatory genes, a SNP in HMGCR gene, middle age, gender, low HDL and diabetes were very informative variables to predict the risk of AMI.

The effect of a new symbiotic formulation on plasma levels and peripheral blood mononuclear cell expression of some pro-inflammatory cytokines in patients with ulcerative colitis: a pilot study

BACKGROUND

During intestinal inflammation white blood cells are recruited from the blood, and they represent the major contributors to tissue perpetuation of inflammation via their production of chemokines and proinflammatory cytokines.

OBJECTIVES

Investigate the effect of a symbiotic formulation containing Lactobacillus Paracasei B 20160 versus placebo, on serum levels of interleukin (IL)-6, tumor necrosis factor (TNF)alpha, IL-8, IL-1beta and IL-10 and on mRNA lymphomonocyte expression of TNFalpha, IL-8 and IL-1beta in patients with ulcerative colitis.

MATERIALS AND METHODS

Eighteen patients entered the study with histologically proven not complicated ulcerative colitis, treated with mesalazine. Patients were treated for 8 weeks (9 with symbiotic and 9 with placebo). Serum levels of IL-6, TNFalpha, IL-8, IL-1beta and IL-10 were measured using a commercially available sandwich ELISA kit. RT-PCR analysis was performed on total RNA isolated from peripheral lymphomonocytes.

RESULTS

In basal condition, there was an increase of serum levels of TNFalpha, IL-6, and IL-8. The treatment with symbiotic significantly decreased serum levels of the last two cytokines (IL-6 and IL-8). In lymphocytes, the treatment with the symbiotic don't significantly reduced the mRNA expression of TNFalpha and IL-1beta, while that of IL-8 was strongly and significantly decreased.

CONCLUSION

Our preliminary results suggest that a symbiotic formulation containing Lactobacillus paracasei significantly improves the plasma and lymphocyte content of some proinflammatory cytokines.

Auto-Contractive Maps: an artificial adaptive system for data mining. An application to Alzheimer disease

This article presents a new paradigm of Artificial Neural Networks (ANNs): the Auto-Contractive Maps (Auto-CM). The Auto-CM differ from the traditional ANNs under many viewpoints: the Auto-CM start their learning task without a random initialization of their weights, they meet their convergence criterion when all their output nodes become null, their weights matrix develops a data driven warping of the original Euclidean space, they show suitable topological properties, etc. Further two new algorithms, theoretically linked to Auto-CM are presented: the first one is useful to evaluate the complexity and the topological information of any kind of connected graph: the H Function is the index to measure the global hubness of the graph generated by the Auto-CM weights matrix. The second one is named Maximally Regular Graph (MRG) and it is an development of the traditionally Minimum Spanning Tree (MST). Finally, Auto-CM and MRG, with the support of the H Function, are applied to a real complex dataset about Alzheimer disease: this data come from the very known Nuns Study, where variables measuring the abilities of normal and Alzheimer subject during their lifespan and variables measuring the number of the plaques and of the tangles in their brain after their death. The example of the Alzheimer data base is extremely useful to figure out how this new approach can help to re design bottom-up the overall structure of factors related to a complex disease like this.

International experience on the use of artificial neural networks in gastroenterology

In this paper, we reconsider the scientific background for the use of artificial intelligence tools in medicine. A review of some recent significant papers shows that artificial neural networks, the more advanced and effective artificial intelligence technique, can improve the classification accuracy and survival prediction of a number of gastrointestinal diseases. We discuss the 'added value' the use of artificial neural networks-based tools can bring in the field of gastroenterology, both at research and clinical application level, when compared with traditional statistical or clinical-pathological methods.

In vivo association to human colon of Lactobacillus paracasei B21060: map from biopsies

BACKGROUND

Adhesion to the intestinal mucosa is one of the main suitable properties for probiotic bacteria. Several in vitro studies have been published, but a very few data are available about the in vivo adhesion to intestinal surfaces of probiotics. Moreover, there are no data regarding the distribution of a probiotic strain along the entire intestine.

AIM

The present study aimed to preliminary evaluate the intestinal recovery of a new synbiotic formulation containing Lactobacillus paracasei B21060.

METHODS

Seven volunteers participated in the study. Subjects assumed three times a day for 15 days a sachet with a synbiotic preparation containing 5 x 10(9)CFUs of Lactobacillus paracasei strain B21060. Samples were recovered from the faeces and from the cecum, transverse, descending and sigmoid colon.

RESULTS

Identification at strain level showed that following administration, strain B21060 could be recovered from all sampled sites (except in one subject), representing 66.6% of the total vancomycin insensitive CFUs isolated from faecal samples, and 74.7% isolated from colonic samples.

CONCLUSIONS

Our results demonstrate that Lactobacillus paracasei B21060 probiotic strain is able to temporarily associate throughout the different sites of the entire intestinal tract.

Non-linear associations between laryngo-pharyngeal symptoms of gastro-oesophageal reflux disease: clues from artificial intelligence analysis

The relationship between the different symptoms of gastro-oesophageal reflux disease remain markedly obscure due to the high underlying non-linearity and the lack of studies focusing on the problem. Aim of this study was to evaluate the hidden relationships between the triad of symptoms related to gastro-oesophageal reflux disease using advanced mathematical techniques, borrowed from the artificial intelligence field, in a cohort of patients with oesophagitis. A total of 388 patients (from 60 centres) with endoscopic evidence of oesophagitis were recruited. The severity of oesophagitis was scored by means of the Savary-Miller classification. PST algorithm was employed. This study shows that laryngo-pharyngeal symptoms related to gastro-oesophageal reflux disease are correlated even if in a non-linear way.

Complexity of attrition in the treatment of obesity: clues from a structured telephone interview

OBJECTIVES

To investigate the causes of attrition reported by obese patients treated by medical centres.

DESIGN

Observational study.

SETTING

Obese patients enrolled in a long-term study involving 18 Italian medical centres.

PARTICIPANTS

A total of 940 obese patients (727 female; mean age, 49 years; mean BMI, 38.6 kg/m2).

MEASUREMENTS

Causes of attrition reported by dropouts during a structured telephone interview.

RESULTS

After a median observation period of 41 months (range, 25-50), 766 of 940 patients (81.5%) discontinued treatment. Sixty-two per cent of total dropout occurred in the first year of follow-up. Seventy-four per cent of dropouts reported a single primary reasons for treatment interruption. Two primary reasons were reported by 22.4% of patients, and three reasons by 3.4%. Practical difficulties, alone or in combination, were reported by more than half of dropouts (55%), and were the leading cause of attrition followed by perceived failure of treatment. Among practical difficulties, family problems or problems at work and logistics, coupled with health problems other than obesity, were the most frequent reasons of attrition, but also a perceived sense of abandonment or a bad interaction with therapists were frequently reported.

CONCLUSION

Practical difficulties and psychological problems are the most important reasons of attrition reported by patients. A therapeutic alliance addressing these issues has a large potential to reduce treatment interruption and to improve outcome in obesity.

Fire-eater's pneumonitis

The authors report a case of acute respiratory failure that fulfils the diagnostic criteria for fire-eater's pneumonitis; pathological features, usually described only in experimental works on animals, are also discussed.

Assessment of the role of genetic polymorphism in venous thrombosis through artificial neural networks

PURPOSE

To assess the role of genetic polymorphisms in venous thrombosis events (VTE) using Artificial Neural Networks (ANNs), a model for solving non-linear problems frequently associated with complex biological systems, due to interactions between biological, genetic and environmental factors.

METHODS

A database was generated from a case-control study of venous thrombosis, using 238 patients and 211 controls. The database of 64 variables included age, gender and a panel of 62 genetic variants. Three different ANNs were compared, with logistic regression for the accuracy of predicting cases and controls.

RESULTS

ANNs yielded a better performance than the logistic regression algorithm. Indeed, through ANNs models, the 62 variables related to genetic variants were first reduced to a set of 9, and then of 3 (MTHFR 677 C/T, FV arg506gln, ICAM1 gly214arg).

CONCLUSIONS

The findings of this study illustrate the power of ANN in evaluating multifactorial data, and show that the different sensitivities of the models of elaboration are related to the characteristics of the data. This may contribute to a better understanding of the role played by genetic polymorphisms in VTE, and help to define, if possible, a test panel of genetic variants to estimate an individual's probability of developing the disease.

An optimized experimental protocol based on neuro-evolutionary algorithms application to the classification of dyspeptic patients and to the prediction of the effectiveness of their treatment

OBJECTIVE

This paper aims to present a specific optimized experimental protocol (EP) for classification and/or prediction problems. The neuro-evolutionary algorithms on which it is based and its application with two selected real cases are described in detail. The first application addresses the problem of classifying the functional (FD) or organic (OD) forms of dyspepsia; the second relates to the problem of predicting the 6-month follow-up outcome of dyspeptic patients treated by helicobacter pylori (HP) eradication therapy.

METHODS AND MATERIAL

The database built by the multicentre observational study, performed in Italy by the NUD-look Study Group, provided the material studied: a collection of data from 861 patients with previously uninvestigated dyspepsia, being referred for upper gastrointestinal endoscopy to 42 Italian Endoscopic Services. The proposed EP makes use of techniques based on advanced neuro-evolutionary systems (NESs) and is structured in phases and steps. The use of specific input selection (IS) and training and testing (T and T) techniques together with genetic doping (GenD) algorithm is described in detail, as well as the steps taken in the two benchmark and optimization protocol phases.

RESULTS

In terms of accuracy results, a value of 79.64% was achieved during optimization, with mean benchmark values of 64.90% for the linear discriminant analysis (LDA) and 68.15% for the multi layer perceptron (MLP), for the classification task. A value of 88.61% was achieved during optimization for the prediction task, with mean benchmark values of 49.32% for the LDA and 70.05% for the MLP.

CONCLUSIONS

The proposed EP has led to the construction of inductors that are viable and usable on medical data which is representative but highly not linear. In particular, for the classification problem, these new inductors may be effectively used on the basal examination data to support doctors in deciding whether to avoid endoscopic examinations; whereas, in the prediction problem, they may support doctors' decisions about the advisability of eradication therapy. In both cases the variables selected indicate the possibility of reducing the data collection effort and also of providing information that can be used for general investigations on symptom relevance.

Snoring, hypertension and Type 2 diabetes in obesity. Protection by physical activity

Sleep-related breathing disorders are recognized as major health problems in obesity. They are involved in both hypertension and Type 2 diabetes, through mechanisms possibly related to increased sympathetic tone. We studied the association of habitual snoring with diabetes, hypertension, weight cycling and physical activity in a large Italian database of treatment-seeking obese subjects. Clinical and behavioral data were assessed by standardized questionnaires. Consecutive data of 1890 obese patients were analyzed [average body mass index (BMI), 38.2 kg/m2, median age: 46 yr, 78% females], from 25 obesity Italian centers, with low prevalence of clinical manifestations of cardiovascular disease. Habitual snoring was reported in 56% of the cases, and was associated with day-time sleepiness. The prevalence increased with obesity class and waist circumference, and was positively associated with weight cycling and weight gain since the age of 20, and smoking. Regular physical activity had a protective effect. Snoring was associated with diabetes and hypertension at univariate analysis, but in multivariate analysis an independent effect was only observed for hypertension. After adjustment for age, gender and BMI, physical activity maintained an independent, protective effect on both snoring (odds ratio 0.65, 95% confidence interval 0.49-0.84; p=0.001), diabetes (0.50, 0.30-0.86; p=0.011) and hypertension (0.71, 0.53-0.95; p=0.023). We conclude that in treatment-seeking, obese subjects with low prevalence of cardiovascular disease, snoring independently increases the risk of hypertension, whereas physical activity exerts a protection on both snoring and complications. These data underline the importance of lifestyle interventions to limit the burden of obesity and associated diseases.

Acute eosinophilic pneumonia with respiratory failure: a case likely triggered by cigarette smoking

The authors report a case of acute respiratory failure that fulfils the diagnostic criteria for acute eosinophilic pneumonia. Bronchoalveolar lavage eosinophilia and eosinophilic lung diseases are also discussed. The pathogenetic events, including the role of IL-5, eotaxin 1 and 2 and VEGF are emphasised.

Psychological and social aspects in management of Alzheimer’s patients: an inquiry among caregivers

A survey in the cities of Genoa and Savona (Italy) was performed to examine stress levels in caregivers of patients with Alzheimer's disease in the context of a project of the Italian Ministry of Health named Cronos. It offered free anticholinesterase inhibitor therapy to patients who addressed dedicated Neurological Units; in this occasion caregivers could be invited to express the main difficulties encountered in managing demented people during an interview conducted by health personnel of the Neurophysiology Service. Caregivers were mainly women, daughters or spouses, with a medium educational level, retired, housekeepers, employees or teachers; they claimed a lowering of economic standard of living of the family owing to extra expenses for assistance. Satisfaction was expressed towards specialists, while support by general practitioners and other sanitary services was usually lacking and money contribution from the government or territorial services was considered inadequate. From the emotional point of view, caregivers claim loss of free time, friendships and hobbies, and feel isolated in the social context; sometimes the patient's death is thought of as a solution. A strong need for information and support is clearly emerging and any further interventions should take these requirements into consideration.

Contribution of artificial neural networks to the classification and treatment of patients with uninvestigated dyspepsia

OBJECTIVES

To verify whether symptoms reported by patients with uninvestigated dyspepsia might be helpful in either classifying functional from organic dyspepsia (1st experiment), or recognising which Helicobacter pylori infected patients may benefit from eradication therapy (2nd experiment).

METHODS

We compared the performance of artificial neural networks and linear discriminant analysis in two experiments on a database including socio-demographic features, past medical history, alarming symptoms, and symptoms at presentation of 860 patients with uninvestigated dyspepsia enrolled in a large observational multi-centre Italian study.

RESULTS

In the 1st experiment, the best prediction for organic disease was given by the Sine Net model (specificity of 87.6% with 13 patients misclassified) and the best prediction for functional dyspepsia by the FF Bp model (sensitivity of 83.4% with 56 patients misclassified). The highest global accuracy of linear discriminant analysis was 65.1%, with 150 patients misclassified. In the 2nd experiment, the highest predictive performance was provided by the SelfDASn model: all infected patients who became symptom-free after successful eradicating treatment were correctly classified, whereas nine errors were made in forecasting patients who did not benefit from such a therapy. The highest global performance of linear discriminant analysis was 53.2%, with 37 patients misclassified.

CONCLUSIONS

In patients with uninvestigated dyspepsia, artificial neural networks might have potential for categorising those affected by either organic or functional dyspepsia, as well as for identifying all Helicobacter pylori infected dyspeptic patients who will benefit from eradication.

The QUOVADIS Study: features of obese Italian patients seeking treatment at specialist centers

Obesity is a major risk factor for several chronic diseases, but the burden associated with it also extends to psychosocial areas and to perceived health status. In 1999 an observational study on health-related quality of life in obesity was planned. The study was entirely web-based. Case Report Forms and the individual items of 7 self-administered questionnaires were directly implemented on a general database via an extranet system from 25 Italian centers. By December 2001, after enrolment had stopped, the database included anthropometric, socioeconomic and clinical data of 1944 patients (78% females). Weight-cycling was reported in over 80% of cases, overeating in 60-65%, structured physical activity in only 13-15%. Several chronic illnesses were associated. Whereas the prevalence of diabetes and hypertension was related to the degree of obesity, hyperlipidemia and coronary heart disease did not increase further with increasing obesity. A disturbed psychological mood was twice more common in females. Concern for present health was the main reason for seeking treatment in both genders; concern for body appearance was more common in females. Male subjects were more frequently assigned to dietary counseling and physical exercise, whereas in females psychotherapy was more frequently considered. Various forms of behavioral approach were planned in approximately 50% of patients. Finally, very few patients were initially considered for pharmacological intervention or bariatric surgery. The study provides a comprehensive picture of Italian patients seeking treatment for obesity. Data on perceived health status, psychological well being, body image awareness, eating behavior disorders and psychopathological distress will provide clues to a comprehensive assessment of obesity, the effects of treatments and reasons for failure.

Dyspepsia and Helicobacter pylori infection: a prospective multicentre observational study

OBJECTIVES

Dyspepsia still represents an unsolved clinical enigma.

AIM

The aims of this study were to determine whether symptoms and Helicobacter pylori infection are predictors of organic disease in uninvestigated dyspepsia, and if H. pylori eradication improves symptoms in functional dyspepsia.

METHODS

An observational study was performed on outpatients with uninvestigated dyspepsia. Symptoms were scored and H. pylori status determined. Patients with functional dyspepsia and H. pylori infection were randomly given either a standard eradicating treatment or a 1-month course of empirical treatment. The latter was also given to functional dyspeptic patients without infection. Symptoms were re-assessed in functional dyspeptic patients at 2- and 6-month follow-up visits. Patients receiving eradicating treatment were re-tested for H. pylori at the 2 month visit.

RESULTS

A total of 860 patients were studied and 605 (70.3%) were affected by functional dyspepsia. H. pylori infection was diagnosed in 71.8% of patients with organic dyspepsia and in 65.0% with functional dyspepsia (p=0.053). Male sex, anaemia, smoking habit, age over 45 years, and severe epigastric pain, but not H. pylori infection, were independent predictors of organic disease. Symptoms significantly improved in most functional dyspeptic patients regardless of their H. pylori status and type of treatment.

CONCLUSION

H. pylori infection is not a strong predictor of organic disease in uninvestigated dyspepsia. H. pylori eradication is not essential to improve symptoms in functional dyspepsia.

Nodule ultrastructure and initial growth of Anadenanthera peregrina (L.) Speg. var. falcata (Benth.) altschul plants infected with rhizobia

The anatomy and ultrastructure of root nodules of Anadenanthera peregrina var. falcata (Leguminosae-Mimosoideae) were analysed, as was plant growth. To ensure that nodules developed, seedlings were inoculated with a mixture of six strains of rhizobia. Nodules were produced that differed in appearance-and probably also effectiveness-but their structure was similar and they showed characteristics typical of indeterminate nodules, such as persistent meristematic tissue and a gradient of cells at different stages of development. Many starch grains were present in inner cortex cells and interstitial cells of infected tissue. Infected cells were densely packed with bacteroids, which contained many poly-beta-hydroxybutyrate granules. The high incidence of these granules, together with high levels of starch accumulation in interstitial cells, suggested low N2-fixation efficiency of the rhizobia isolates used for inoculation. In the symbiosomes of early-senescent infected cells, reticulum-like structures, small vesicles and a fibrillar material were observed; these may be related to bacteroid degradation. In the cytoplasm of late-senescent infected cells, many vesicles and membrane-like structures were observed, probably associated with membrane degradation of bacteroids and peribacteroids. The total biomass of plants inoculated with rhizobia was low and their xylopodia and shoots had low levels of N compared with noninoculated plants fertilized with ammonium nitrate. However, inoculated plants did not show N-deficiency symptoms and grew better than non-inoculated plants without N fertilization. These growth results, together with ultrastructural observations of nodules, suggest that nitrogen fixation of rhizobia isolates associated with Anadenanthera peregrina var. falcata roots is poor.

Combination antiretroviral therapy in 100 HIV-1-infected pregnant women

BACKGROUND

In recent years, combination antiretroviral therapy has substantially improved the prognosis of human immunodeficiency virus type-1 (HIV-1) infection. However, at present, information regarding the effects of these regimens during pregnancy is limited.

METHODS

Side-effects, vertical transmission rate and neonatal outcome associated with different combination therapies were evaluated retrospectively in a consecutive series of 100 women who attended the II Department of Obstetrics and Gynecology for the management of HIV-1 infection in pregnancy.

RESULTS

Antiretroviral treatment was initiated at a median of 16 weeks gestation with a range from pre-pregnancy until 31 weeks gestation. Twentythree women continued their pre-pregnancy therapy during the first trimester of gestation. Protease inhibitors were incorporated in 23 of the final therapeutic regimens. Twentyfive women did not receive zidovudine. Most women (97) delivered by Caesarean section and none breast-fed. Prematurity rate for the entire series was 19%. When women who actively used illicit drugs were excluded, only seven of 69 (10%) women were found to deliver prematurely. The use of protease inhibitors was limited by an elevated frequency of severe gastrointestinal disturbances. The rate of congenital malformations did not appear to differ significantly from that reported in the literature for the general population. Only one of 102 live newborns was found to be HIV-1-infected (1.0%, 95% confidence interval; 0.3-4.6%).

CONCLUSIONS

The present findings confirm the remarkable efficacy of combination antiretroviral therapy, Caesarean section and refraining from breast-feeding in lowering the rate of vertical HIV-1 transmission. Moreover, they are suggestive that combination antiretroviral therapy may not be related to major neonatal toxicity. The necessity to discontinue the therapy during the first trimester of pregnancy and to systematically incorporate zidovudine into combination regimens is discussed.

Design, synthesis, and characterization of the antitumor activity of novel ceramide analogues

A deficiency in apoptosis is one of the key events in the proliferation and resistance of malignant cells to antitumor agents; for these reasons, the search for apoptosis-inducing drugs represents a valuable approach for the development of novel anticancer therapies. In this study we report the first example of conformationally restrained analogues of ceramide (compounds 1-4), where the polar portion of the molecule has been replaced by a thiouracil (1, 3) or uracil (2, 4) ring. The evaluation of their biologic activity on CCRF-CEM human leukemia cells demonstrated that the most active was compound 1 followed by compound 2 (mean 50% inhibition of cell proliferation [IC(50)] 1.7 and 7.9 microM, respectively), while compounds 3 and 4 were inactive, as were uracil, thiouracil, and 5,6-dimethyluracil, the pyrimidine moieties of compounds 1-4. For comparison, the IC(50) of the reference substance, the cell-permeable C2-ceramide, was 31.6 microM. Compounds 1 and 2 and C2-ceramide were able to trigger apoptosis, as shown by the occurrence of DNA and nuclear fragmentation, and to release cytochrome c from treated cells. The treatment of female CD-1 nu/nu athymic mice bearing a WiDr human colon xenograft with the most active compound 1 at 2, 10, 50, and 200 mg/kg ip daily for 10 days resulted in an antitumor effect that was equivalent at 50 mg/kg or superior (200 mg/kg) to that of cyclophosphamide, 20 mg/kg ip daily, delivered on the same schedule, with markedly lower systemic toxicity. In conclusion, the present study demonstrates that the new ceramide analogues 1 and 2 are characterized by in vitro and in vivo antitumor activity and low toxicity.

Predictors of operative time in multicenter port-access valve registry: institutional differences in learning

BACKGROUND

The predictors of operative time and the effects of learning in isolated valve operations using port-access techniques have not been defined.

METHODS

Analysis of covariance was used to examine the determinants of procedure time, pump time, and aortic clamp time. In the largest prospective, registry of patients undergoing isolated aortic valve replacement (AVR, N=199), mitral repair (MVP, N=307), or mitral replacement (MVR, N=232) using port-access techniques 1997-1999 at 27 institutions.

RESULTS

Institutional case volume ranged from one to 214 (median 6). Operative time was longer in redo procedures (5.3 +/- 1.6 vs. 4.4 +/- 1.3 hr, p = 0.0001), longer with MVP or MVR vs. AVR (4.8 +/- 1.2 vs. 5.0 +/- 1.5 vs. 3.8 +/- 1.2 hr, p = 0.0001), and decreased with case number (mean decrease 1.00 +/- 0.19 min/case, p = 0.04). Operative time also varied between institutions (p = 0.001). Rate of learning (decrease in time per case) varied significantly between institutions only for MVP (p = 0.03). Similar analysis showed that pump time and clamp times did not significantly change over time (p > 0.17) but varied significantly between institutions. Institutional volume did not affect operative, pump, or clamp times or rate of learning (decrease in operative time/case).

CONCLUSIONS

These prospective registry data demonstrate that, for port-access valve procedures, procedure times continue to improve (learning) even after 100 cases. Procedure time and learning are affected by institutional differences and by the type of procedure, but are little affected by institutional volume. This data provides a model to understand learning of new surgical procedures, and this data suggests that port-access valve procedures can be mastered by a variety of institutions.

Role of motor imitation in traversability of surfaces by walking infants

The ecological approach by Gibson stressed the role of visual cues in toddlers' locomotor activities. In particular, a rigid surface offers more traversability "affordances" to walkers (13-16 mo. old) than a deformable surface. On the other hand, imitation plays a relevant role in human behaviors. In our study a group of 17 walking infants (12-19 mo.) were asked to choose between locomoting on a rigid versus a deformable surface after having seen an older child walking on the deformable surface. A control group of 19 infants were asked to do the same task without having seen a model. The task was repeated three times. No relevant differences appeared between the two groups as to the choice of surfaces: the rigid surface was preferred by both groups. Some slight differences in the behavior of the experimental group were seen as a result of observing the model. Clearly, however, social stimulus. such as the sight of an older child performing a specific task, does not overcome the affordances which induce infants not to walk on the deformable surface.

Acquired aorta-pulmonary artery fistula: diagnosis by multiple imaging modalities

Acquired communication between the aorta and the pulmonary artery is a rare phenomenon. We describe two patients with a thoracic aortic aneurysm in whom the diagnosis of a communication with the pulmonary artery was first made on transthoracic echocardiography and then more completely elucidated by means of multiple imaging modalities: transesophageal echocardiography, epiaortic ultrasound, computed tomography, and magnetic resonance imaging. Representative images from these complementary studies are presented. A successful repair of the fistula was subsequently accomplished in both patients.

Speculoscopy for Triage of Patients with an Abnormal Pap Smear: Data from the GISPE Study

OBJECTIVE

This study evaluates the performance of Papanicolaou smear combined with speculoscopy in improving the predictive value of minor grade cervical cytological abnormalities.

MATERIALS AND METHODS

A total of 3,300 asymptomatic women who had routine cervical smears were studied in 32 Italian centers. All these women underwent Pap smear and speculoscopy. The women positive at Pap smear or speculoscopy (n = 908) were referred for colposcopy and directed punch biopsy/endocervical curettage was performed when appropriate.

RESULTS

Of the 908 patients referred for colposcopy, 538 underwent biopsy; 92 of these had a cervical lesion (cervical intraepithelial neoplasia [CIN]) confirmed on histology (67 CIN1 and 25 CIN2-3). Speculoscopy pointed out an area to biopsy in 84% of the CIN1 and in 75% of the CIN2-3 cases among women who showed minor (low-grade squamous intraepithelial lesion or less) cytological abnormalities.

CONCLUSIONS

The potential combination of cytology and speculoscopy as an intermediate test in patients with minor grade cytologic (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion) cervical changes may decrease the number of recalls and directed biopsies in a cost-effective manner.

Prevalence of subclinical hypothyroidism in a population living in the Milan metropolitan area

Subclinical hypothyroidism is a condition characterized by increased levels of thyroid-stimulating hormone (TSH) associated with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). The exact prevalence of this condition in Italy is not known. The aim of this study was to assess the presence of subclinical hypothyroidism in 1001 subjects living in the Milan area (age 17-89) and apparently free from thyroid pathology. This sample which had applied to a large laboratory centre (Centro Diagnostico Italiano, Milano) for a routine check-up was seen from April to July 1996. A serum TSH assay was performed using a highly sensitive immunoenzymatic method, while an FT3 and FT4 assay was performed by means of a radioimmunologic method using commercial kits. The prevalence of subclinical hypothyroidism in the total population proved to be 4.7% (95% CI-Confidence Interval: 3.4-6.0). Sex stratification showed a prevalence of 6.1% in females and 3.4% in males. Prevalence in patients up to 65 was 4.2%. This value increased up to 8.0% in subjects over 65. By combining these variables, in females >65 prevalence increased to 11.3%. Overall, symptoms typical of overt hypothyroidism were found in 58.3% of patients suffering from subclinical hypothyroidism and in 39.9% of healthy subjects (p<0.02). The results of this study show that there is a significant presence (about 5%) of subclinical hypothyroidism in this population and that its frequency is more than doubled in women over 65. Early treatment might reduce the progression to overt hypothyroidism. The benefits of such a procedure were recently suggested by a decision making modelling approach applied to the Italian environment.