984 ARRHYTHMOGENIC DYSPLASIA: JUST A PROBLEM OF THE YOUNG?

Arrhythmogenic dysplasia is a disease of genetic aetiology characterised by the progressive replacement of functioning myocardium by fibro-adipose tissue with high arrhythmogenic potential, as well as by morpho-functional impairment. Molecular genetic studies have revealed a deficiency of demosomal proteins such as placoglobin, desmoglein, desmoplazine, placophylline and desmocollin. It usually begins at a young age and in sports subjects. It mainly affects the right ventricle, although over time it can also affect the left sections due to a biventricular alteration of the heart pump. Forms with major left-sided involvement have been described in the literature, but these are rare.

A 73-year-old man, a sportsman with over 40 marathons, presented with an episode of sustained VT during exercise in 2011. Admitted to our hospital, he was diagnosed with arrhythmogenic cardiomyopathy and was subsequently implanted with an ICD-DR mod.Teligen 100F. After 3 months, however, there was a new episode of VT, so it was decided to subject the patient to transcatheter ablation with radiofrequency, using an endocardial approach, which proved ineffective. Two months later, a new attempt at radioablation with an endocardial approach. Due to the persistence of arrhythmic symptoms, sustained VT episodes, in February 2012 it was decided to proceed with a third ablation, but adopting an endo-epicardial approach, with apparent resolution of the symptomatology. After severals episodes of atrial fibrillation, he underwent a new ablation with pulmonary vein isolation and ablation line at the level of the cavo-tricuspid isthmus in August 2020. On echocardiogram, the left ventricle had normal dimensions with upper limit thicknesses, diffuse parietal hypokinesis with markedly reduced EF (30%), dilated right ventricle (DTD 48 mm) with parietal hypertrabeculature and free wall hypokinesis (TAPSE 1.4) and dilated right atrium. In May 2020 new relapse of atrial fibrillation successfully cardioverted, maintenance therapy set up with sotalol.

In the literature, mainly forms of arrhythmogenic dysplasia in youth (30 years) have been described, whereas older forms appear to be rare. A search of the Medline database (National Library of Medicine, Bethesda, MD) found 5 cases of ARVD among the elderly; all these patients had died and were diagnosed by histology. The diagnosis is multi-parametric and the main aim of therapy is the prevention of sudden cardiac death. Currently, ICD defibrillator implantation is the only effective therapy for the prevention of sudden death. New drug therapies, radiofrequency ablation and defibrillators are likely to have a favourable impact on the survival of these patients and make it not unlikely that elderly patients with ARVD will be present. The possibility of a late onset of the disease should also be suspected.

Cluster ions to preserve ready-to-eat table grape during cold storage

The demand for natural fresh-cut products characterized by high quality has promoted the research for non-chemical post-harvest treatments. The aim of this study was to evaluate the effect of air purification with the ion generator Ionny® (Fruit control Equipment, Italy) on fresh-cut table grape quality during post-harvest storage. The air purification was the effect of positively and negatively charged ions generated by the ion generator at atmospheric pressure. The treatment was applied in a storage room on fresh-cut table grape at 0°C for 21 days. Berries were analyzed for weight loss, flesh firmness, skin color, total phenols, acidity, total soluble solids, vitamin C and total yeasts/molds. Results showed that ions treatment positively influenced the quality maintenance of the product, by improving color retention, limiting weight losses and preserving high phenolic content during postharvest storage. Moreover, in cv Red Globe treated berries showed higher soluble solids, acidity, lightness and lower firmness losses, while in cv Italia the ions treatment limited the growth of the microorganisms.

Long-term changes in the breeding period diet of Bonelli

Context Dietary analyses are essential to achieve a better understanding of animal ecology. In the case of endangered species, assessing dietary requirements is crucial to improve their management and conservation. The Bonelli’s eagle (Aquila fasciata) has experienced a severe decline throughout its breeding range in Europe and, in Italy, fewer than 50 pairs remain, and only in Sicily. This species is subject to major threats, including changes in landscape composition and, consequently, prey availability, which is further aggravated by the occurrence of viral diseases in the case of rabbits. Aims To provide current data on the diet of the Bonelli’s eagle in Sicily during the breeding period and to examine dietary shifts with regard to previous studies conducted in the same study area. To discuss possible implications for conservation of the Italian population of this endangered species. Methods We used a combination of three methods, including pellet analysis, collection of prey remains, and imagery from camera-traps installed at nests, to examine the diet of 12 breeding pairs of Bonelli’s eagle from 2011 to 2017. We compared this information with data collected between 1993 and 1998 in the same study area. Key results In number, birds were the most frequently predated items (61.6%), followed by mammals (36.88%) and reptiles (1.52%). However, in terms of biomass, mammals were the main prey (65.71%), followed by birds (34.12%) and reptiles (0.17%). There was a decrease over the course of the current decade in the consumption of European wild rabbit (Oryctolagus cuniculus), which was compensated for with an increase in both dietary diversity and breadth in bird consumption, a trend not observed in the earlier study in the same region. Conclusions Here, we provide an updated assessment of diet composition of Bonelli’s eagle during the breeding period. Interestingly, we found significant differences within the study period (2011–2017) in terms of frequency of occurrence, percentage of biomass, dietary diversity and dietary breadth in a species at risk. Furthermore, we found significant differences between the two study periods in both frequency and percentage of biomass, with significant changes in the consumption of lagomorphs and birds. Implications Our results indicated that shifts in the diet are linked to changes in prey abundance, which may be contributing to population declines in the Bonelli’s eagle population in Sicily. Overall, measures aimed at increasing main dietary prey should be promoted to favour occupation of new territories and enhance vital demographic parameters (i.e. breeding success and survival rate) of Bonelli’s eagle across the species range. This would be particularly important for small isolated populations such as the Sicilian one.

Supermicrosurgical Lymphaticovenular Anastomosis for a Breast Lymphedema Secondary to vascularized Axillary Lymph Node Flap Transfer

Breast lymphedema (BLE) can occur after breast cancer treatments, but there have been no cases of BLE secondary to lymph node transfer (LNT) using an axillary lymph node (ALN). We report the first case of LNT-related BLE successfully treated with supermicrosurgical lymphaticovenular anastomosis (LVA). A 50-year-old female presented with left BLE after LNT harvesting from the left axilla for the treatment of secondary lower extremity lymphedema in another hospital. Although the left breast did not seem edematous, the patient suffered from sensation of tension and frequent episodes of left breast cellulitis. Since conservative treatments were not effective, LVA was performed at the lateral thoracic region. A 0.5 mm lymphatic vessel was found and anastomosed to a nearby 0.35 mm vein in an intima-to-intima coaptation manner. After the LVA, the patient experienced no sensation of tension or further cellulitis attacks. Although rarely encountered, BLE can occur after axillary LNT, and LVA may be a useful therapeutic option.

Post-ischaemic silencing of p66Shc reduces ischaemia/reperfusion brain injury and its expression correlates to clinical outcome in stroke

AIM

Constitutive genetic deletion of the adaptor protein p66(Shc) was shown to protect from ischaemia/reperfusion injury. Here, we aimed at understanding the molecular mechanisms underlying this effect in stroke and studied p66(Shc) gene regulation in human ischaemic stroke.

METHODS AND RESULTS

Ischaemia/reperfusion brain injury was induced by performing a transient middle cerebral artery occlusion surgery on wild-type mice. After the ischaemic episode and upon reperfusion, small interfering RNA targeting p66(Shc) was injected intravenously. We observed that post-ischaemic p66(Shc) knockdown preserved blood-brain barrier integrity that resulted in improved stroke outcome, as identified by smaller lesion volumes, decreased neurological deficits, and increased survival. Experiments on primary human brain microvascular endothelial cells demonstrated that silencing of the adaptor protein p66(Shc) preserves claudin-5 protein levels during hypoxia/reoxygenation by reducing nicotinamide adenine dinucleotide phosphate oxidase activity and reactive oxygen species production. Further, we found that in peripheral blood monocytes of acute ischaemic stroke patients p66(Shc) gene expression is transiently increased and that this increase correlates with short-term neurological outcome.

CONCLUSION

Post-ischaemic silencing of p66(Shc) upon reperfusion improves stroke outcome in mice while the expression of p66(Shc) gene correlates with short-term outcome in patients with ischaemic stroke.

Analysis of genes, pathways and networks involved in disease severity and age at onset in primary-progressive multiple sclerosis

Background:

The role of genetic factors in influencing the clinical expression of multiple sclerosis (MS) is unclear.

Objective:

The objective of this paper is to identify genes, pathways and networks implicated in age at onset (AAO) and severity, measured using the Multiple Sclerosis Severity Score (MSSS), of primary-progressive MS (PPMS).

Methods:

We conducted a genome-wide association study (GWAS) of 470 PPMS patients of Italian origin:. Allelic association of 296,589 SNPs with AAO and MSSS was calculated. Pathway and network analyses were also conducted using different tools.

Results:

No single association signal exceeded genome-wide significance in AAO and MSSS analyses. Nominally associated genes to AAO and MSSS were enriched in both traits for 10 pathways, including: “oxidative phosphorylation” (FDRAAO=9*10−4; FDRMSSS=3.0*10−2), “citrate (TCA) cycle” (FDRAAO=1.6*10−2; FDRMSSS=3.2*10−3), and “B cell receptor signaling” (FDRAAO=3.1*10−2; FDRMSSS=2.2*10−3). In addition, an enrichment of “chemokine signaling pathway” (FDR=9*10−4) for AAO and of “leukocyte transendothelial migration” (FDR=2.4*10−3) for MSSS trait was observed, among others. Network analysis revealed that p53 and CREB1 were central hubs for AAO and MSSS traits, respectively.

Conclusions:

Despite the fact that no major effect signals emerged in the present GWAS, our data suggest that genetic variants acting in the context of oxidative stress and immune dysfunction could modulate the onset and severity of PPMS.

Stroke care in young patients

The aims of this study were (i) to evaluate the clinical features of a consecutive series of young patients with ischemic stroke and (ii) to assess the changes in the clinical management of these patients over the study period. All consecutive cases of young adults aged 16 to 44 years, with ischemic stroke, that were admitted between 2000 and 2005 in 10 Italian hospitals were included. We retrospectively identified 324 patients. One or more vascular risk factors were present in 71.5% of the patients. With respect to the diagnostic process, an increase in the frequency of cerebral noninvasive angiographic studies and a decrease in the use of digital subtraction angiography were observed (P < 0.001 and P = 0.03, resp.). Undetermined causes decreased over 5-year period of study (P < 0.001). The diagnosis of cardioembolism increased. Thrombolysis was performed for 7.7% of the patients. PFO closure (8%) was the most frequently employed surgical procedure. In conclusion, the clinical care that is given to young patients with ischemic stroke changed over the study period. In particular, we detected an evolution in the diagnostic process and a reduction in the number of undetermined cases.

IL28B polymorphisms are not associated with the response to interferon-β in multiple sclerosis

Recent studies have revealed an association between interleukin 28B (IL28B) and response to IFN-alpha treatment in hepatitis C patients. Here we investigated the influence of IL28B polymorphisms in the response to interferon-beta (IFNβ) in multiple sclerosis (MS) patients. We genotyped two SNPs of the IL28B gene (rs8099917 and rs12979860) in 588 MS patients classified into responders (n=281) and non-responders (n=307) to IFNβ. Combined analysis of the study cohorts showed no significant associations between SNPs rs8099917 and rs12979860 and the response to treatment. These findings do not support a role of IL28B polymorphisms in the response to IFNβ in MS patients.

Novel analogues of Istaroxime, a potent inhibitor of Na(+),K(+)-ATPase: Synthesis, structure-activity relationship and 3D-quantitative structure-activity relationship of derivatives at position 6 on the androstane scaffold

We report the synthesis and biological properties of novel analogues of Istaroxime acting as positive inotropic compounds through the inhibition of the Na(+),K(+)-ATPase. We explored the chemical space around the position 6 of the steroidal scaffold by changing the functional groups at that position and maintaining a basic oximic chain in position 3. Some compounds showed inhibitory potencies of the Na(+),K(+)-ATPase higher than Istaroxime and many of the compounds tested in vivo were safer than digoxin, the classic digitalis compound currently used for the treatment of congestive heart failure as inotropic agent. The 3D-QSAR analyses using comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA) methods have been successfully applied to a set of 63 androstane derivatives as Na(+),K(+)-ATPase inhibitors. The contour plots provide many useful insights into relationships between structural features and inhibitory potency.

Effect of Potentiation of Cholinergic Tone by Pyridostigmine on the GH Response to GHRH in Elderly Men

The plasma GH response to GHRH (100 micrograms i.v.) was evaluated either alone or after pretreatment with pyridostigmine (120 mg orally 1 h prior to GHRH) in 9 younger men (age range: 22-39 years) and in 9 healthy elderly men (age range: 63-77 years). On a different occasion, subjects were tested with pyridostigmine alone. Basal concentrations of glucose, cortisol, androgens, estrogens, thyroid hormones and GH were similar in all subjects, whereas insulin-like growth factor was lower in elderly men. The GH response to GHRH was significantly lower in the older (mean peak was 6 times higher than baseline) than in the younger group (mean peak was 11.3 times higher than baseline). The pretreatment with pyridostigmine induced a striking increase in the GH response to GHRH in the younger subjects (mean peak was 26 times higher than baseline), whereas it produced only a slight increase in the GHRH-induced GH response in elderly men (mean peak was 8.7 times higher than baseline). When pyridostigmine was given alone, plasma GH levels rose significantly in both groups; however, the pyridostigmine-stimulated GH response was significantly higher in younger (mean peak was 6 times higher than baseline) than in older subjects (mean peak was 2.5 times higher than baseline). These data indicate that the cholinergic stimulatory regulation of GH release is reduced in elderly subjects. Since acetylcholine inhibits hypothalamic somatostatin release, the reduced cholinergic tone in elderly subjects may result in an increased somatostatinergic tone.

Studies on Shelf Life of ``Lateblue'' Highbush Blueberries

There is a considerable scope to mantain the quality and extend shelf-life of perishable and soft fruits such as strawberries, raspberries, and blueberries by developing and evolving packaging strategies. In this work a study on the packaging of blueberries in plastic film for short-to-medium term storage was carried out. Blueberries cv Lateblue were hand-picked from a commercial plantation and packaged in different barrier films. Four commercially available films were used as packaging materials: two micro-perforated (0.3 mm and 1 mm in diameter), a non-perforated and a macro-perforated (6 mm in diameter). All the samples were stored at 4 °C for 15 days. The benefits of small packages (consumer packs), were evaluated through chemical (total soluble solid content (TSS), titratable acidity and pH), visual (color intensity, surface shine, firmness by touch, intensity of odor, and overall appearance) and sensory (crispness, sweet taste, acidic taste, total flavor, and overall appreciation) evaluation. The berries packaged in micro-perforated (1 mm in diameter) and non-perforated film maintained better quality attributes (high TSS content and titratble acidity) throughout the cold storage. The non-perforated film maintained also berry crispness and a good intensity of flavor. Non and micro-perforated packaging films gave the best results and appeared to be a feasible practice in order to ensure good quality during medium-term storage of blueberries. Moreover nonperforated film treatment was the only treatment that reduced in little or no significant pathogen-induced decay during cold storage.

Istaroxime, a stimulator of sarcoplasmic reticulum calcium adenosine triphosphatase isoform 2a activity, as a novel therapeutic approach to heart failure

Interventions involving calcium cycling may represent a promising approach to heart failure (HF) therapy because calcium handling is known to be deranged in human and experimental HF. Istaroxime is a sodium-potassium adenosine triphosphatase (ATPase) inhibitor with the unique property of increasing sarcoplasmic reticulum calcium ATPase (SERCA) isoform 2a (SERCA2a) activity. Because this was demonstrated in normal experimental models, we investigated whether istaroxime is able to improve global cardiac function and stimulate SERCA in failing hearts. In guinea pigs with 3-month aortic banding (AoB), echocardiographic results showed that istaroxime intravenous infusion (0.11 mg/kg per min) significantly increased both indices of contraction and relaxation (fractional shortening, +18+/-3.7%; aortic flow rate, +19+/-2.9%; peak myocardial systolic velocity, +36+/-7%; circumferential fiber shortening, +24+/-4.1%; peak atrial flow velocity, +69+/-8.6%; isovolumic relaxation time, +19+/-6.9%; and peak myocardial early diastolic velocity, +42+/-12%). In left ventricular sarcoplasmic reticulum microsomes from AoB animals, 100 nmol/L istaroxime normalized the depressed (-32%) SERCA2a maximum velocity and increased SERCA activity (+17%). In muscle strips from hearts from patients undergoing cardiac transplantation, istaroxime (0.1-1.0 micromol/L) increased (in a concentration-dependent manner) developed tension, the maximum and minimum first derivative of tension, and absolute velocity of contraction, while stimulating SERCA activity in sarcoplasmic reticulum microsomes at physiologic free calcium concentrations. In conclusion, istaroxime is presently the only available compound that stimulates SERCA2a activity and produces a luso-inotropic effect in HF.

Surgical treatment of patent omphalomesenteric duct presenting as faecal umbilical discharge

A newborn infant with patent omphalomesenteric duct (POMD), who presented faecal umbilical discharge, was treated with a semicircular periumbilical incision up to the abdominal cavity. The omphalomesenteric duct was followed up to the junction with the small intestine and there resected. The abdominal wall was closed without resection of the umbilicus.

Effect of melatonin on hypoglycemia and metoclopramide-stimulated arginine vasopressin secretion in normal men

The present study was performed in order to establish whether melatonin (MEL) plays a role in the regulation of arginine vasopressin secretion (AVP) in normal human subjects. For this purpose, the effects of an oral administration of 6 or 12 mg MEL on basal and metoclopramide (MCP)- or hypoglycemia-stimulated AVP secretion was tested in 18 normal men. MCP was given at a dose of 20 mg as an intravenous (i.v.) bolus; hypoglycemia was induced with an i.v. bolus injection of 0.15 IU/kg body weight of insulin. In addition, in view of the well-known inhibitory effect of MEL on the growth hormone (GH) response to hypoglycemia, GH levels were measured during the insulin tolerance test (ITT), as an independent index of MEL activity. MEL did not produce any change in AVP secretory patterns in basal conditions or during the MCP test. In contrast, the mean peak AVP response to hypoglycemia was 2.33 times higher than baseline in the control ITT, whereas it was only 1.77 times higher than baseline in the ITT plus MEL tests. Also, the GH response to hypoglycemia was significantly lower in the presence than in the absence of MEL. For both AVP and GH, the inhibitory effect of MEL during ITT was similar, when either 6 or 12 mg MEL was given. These data indicate an involvement of MEL in the control of the AVP response to hypoglycemia, but not of basal and MCP-induced AVP secretion. In addition, the similar effects of MEL on GH and AVP secretions during ITT suggest that similar neuroendocrine mechanisms underlie these hormonal responses to hypoglycemia.

Effect of propionyl-L-carnitine on the mechanics of right and left papillary muscles from volume-overloaded rat hearts

Propionyl-L-carnitine (PLC) was shown to improve global cardiac function in pressure overload hypertrophy by acting directly on muscle mechanics. We investigated whether PLC can effectively ameliorate papillary muscle mechanics in a volume overload (VO) model. We induced VO by constructing an aortocaval anastomosis in adult Wistar rats. Three experimental groups were studied: sham-operated controls and untreated and PLC-treated VO animals. Isometric function of right and left papillary muscle was studied 16-18 weeks later. PLC was administered in the drinking water at the dose of 180 mg/kg for the last 2 weeks before experiment. One-way analysis of variance (ANOVA) showed that in right papillary muscles from the untreated VO group the time course of the isometric contraction was significantly prolonged [time-to-peak tension (TPT, ms +/- SEM) from 126 +/- 4.9 to 156 +/- 7.1; time from peak tension to 30% relaxation (TRel) from 133 +/- 11.9 to 196 +/- 13.9; n = 11 and 8, respectively], and peak rates of contraction and relaxation normalized over developed tension were significantly decreased in comparison with sham [from (s-1 +/- SEM) 12.9 +/- 0.5 to 10.8 +/- 0.6, and from 7.2 +/- 0.6 to 5.2 +/- 0.4, respectively]. These parameters in the PLC VO group did not differ from sham (TPT, 140 +/- 5.7; TRel, 158 +/- 14.4; +dF/df/DT, 12.2 +/- 0.6; -dF/df/DT, 6.5 +/- 0.5; n = 8). Function of left papillary muscle was not modified by either VO or PLC treatment. Total carnitine levels in either ventricle free walls were unchanged by VO. PLC significantly increased total carnitine content of left ventricle free wall (from 5.4 +/- 0.28 to 7.0 +/- 0.50). The contraction changes observed in the right papillary muscle are likely to depend on the pressure overload occurring in the right chamber; moreover, they are unrelated to tissue carnitine depletion. PLC improved the altered right papillary muscle mechanics without exerting any apparent effect on the functionally normal left papillary muscle. PLC activity is independent of carnitine stores, but may presumably be ascribed to its anaplerotic properties.

Propionyl-L-carnitine prevents myocardial mechanical alterations due to pressure overload in rats

This study investigated if propionyl-L-carnitine (PLC) treatment can directly affect cardiac mechanics, secondary to increase in myocardial carnitine content, in rats with aortic constriction and sham-operated controls. After weaning, rats were fed one of the following diets for 8 wk: 1) a low-carnitine diet (containing 2 nmol/g carnitine); 2) the same diet supplemented with PLC (710 mumol/kg body wt); 3) L-carnitine (LC; 118 mumol/kg body wt, given in tap water; or 4) a standard diet (containing 56 nmol/g carnitine). A 4-wk constriction of the abdominal aorta caused left ventricular hypertrophy associated with significantly prolonged timing parameters and reduced rate of tension decay in papillary muscles. In group 2, however, PLC treatment prevented hypertrophy-induced changes in these parameters and the reduction in unloaded shortening velocity in skinned trabeculae. Finally, PLC treatment maintained the relative proportion of myosin heavy chain isoforms in left ventricular wall of animals subjected to aortic constriction. Both PLC and LC completely prevented carnitine depletion due to hypertrophy and to dietary restriction. Because LC did not modify papillary muscle contractile function, these results demonstrate that PLC affects hypertrophy-induced changes in muscle mechanics and ventricular wall composition independently of tissue carnitine levels.

Different effects of delta-sleep-inducing peptide on arginine-vasopressin and ACTH secretion in normal men

Delta-sleep-inducing peptide (DSIP) is a well-known inhibitor of pituitary ACTH secretion. In order to evaluate the possible influence of DSIP on basal arginine-vasopressin (AVP) secretion and/or on the AVP-response to osmotic and pressure/volumetric stimuli, DSIP (25 nmol/kg) was infused in 10 min to 8 normal men (23-34 years old) just before a 2-hour infusion of normal saline (NaCl 0.9%; DSIP test) or hypertonic saline (0.51 M NaCl; osmotic test) or before an orthostatic test (standing upright and maintaining an orthostatic position for 20 min). In different occasions, a 10-min infusion of normal saline (placebo) was given instead of DSIP. In an additional 7 subjects, DSIP or placebo was given 60 min before hypertonic saline or the orthostatic test. The results obtained after the administration of DSIP at time 0 and at -60 min were similar.

RESULTS

The administration of DSIP or normal saline alone did not change the concentrations of circulating AVP. A slight physiological decline in ACTH levels was observed during saline infusion, whereas a significant decrease in ACTH levels was induced by DSIP administration. Osmotic stimulation of AVP secretion by hypertonic NaCl induced a significant increase in plasma AVP concentrations which was not modified by DSIP administration. The ACTH secretory patterns during hypertonic NaCl and hypertonic NaCl plus DSIP were similar to those observed during normal saline and normal saline plus DSIP, respectively. The orthostatic test provided similar plasma AVP increments, regardless of the previous treatment with DSIP.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intravenous endothelin on hemodynamics and cardiac contractility in conscious Milan normotensive rats

The effects of endothelin-1 (ET-1) on hemodynamics and cardiac contractility were compared with the responses to angiotensin I (AI) and phenylephrine (PE) in Milan normotensive rats. Intravenous (i.v.) injection of ET-1 (0.8 nmol/kg) initially decreased mean blood pressure (MBP), total peripheral resistance (TPR), and dP/dt (-28 +/- 2, -34.8 +/- 3.7, and -9.4 +/- 1.3%, p less than 0.01, respectively), and increased heart rate (HR), cardiac output (CO), and the velocity of myocardial anterior wall shortening (dL/dt) (11.8 +/- 2.1, 10.4 +/- 2.9, and 28.3 +/- 8.3% p less than 0.05, respectively). These effects were followed by a sustained increase in MBP and TPR and a decrease in CO. As compared with AI (0.25 nmol/kg) and PE (35 nmol/kg), which produced a similar degree of increase in TPR, the reduction in CO induced by ET-1 was more prominent (-25 +/- 2 by ET-1 vs. -14 +/- 2 by AI and -14 +/- 3% by PE, p less than 0.05, respectively). Moreover, ET-1 induced a significant decrease in dP/dt, shortening fraction (SF), and dL/dt (-6.1 +/- 1.6, -35.0 +/- 3.8, and -38.6 +/- 5.5%, p less than 0.01, respectively), whereas these indexes of left ventricle performance were not affected by either AI or PE. Furthermore, the reduction in SF induced by ET-1 was mainly due to the decrease in myocardial diastolic segment length, suggesting reduction in diastolic filling volume.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary myxedema in an adult. Notes on a case]

In the case of adult primary myxedema reported the diagnostic suspicion aroused by objective examination was confirmed by assaying the hypophysial-thyroid hormones (blood T4 and T3 below normal levels) and by the behaviour of certain muscle enzymes (CPK, LDH, GOT) that bore witness to diffuse muscle and bone damage (hypothyroid "myopathy"). The presence of antithyroid antibodies, though in small amounts suggested earlier and unnoticed thyroiditis as a possible aetiopathogenic explanation. The clinical and metabolic picture undoubtedly benefited from treatment with L-Thyroxine.

[In vitro chemo-antibiotic sensitivity of gram-negative bacteria from various biological materials. Comparison between aztreonam and other agents]

527 Gram negative bacterial strains isolated from different biological substances were studied by chemo-antibiotic sensitivity. The examination was carried out by the agar diffusion test (Kirby-Bauer). A very good sensitivity to aztreonam (E. coli, Serratia spp., Klebsiella spp., Proteus spp.), to amikacin (Pseudomonas spp., Enterobacter spp., Citrobacter spp.) and to norfloxacin (Citrobacter spp.) was found. Even when it was not the best, aztreonam was the second (Citrobacter spp.) or the third choice (Pseudomonas spp.), always near to the drug of first choice.

[Risk factors and acute cerebral infarct in patients selected on the basis of blood sugar levels]

Clinical and laboratory abnormalities were examined in relation to diabetes mellitus in a retrospective study of the 120 patients with acute stroke admitted to our medical unit between January 1, 1981 and March 31, 1984, inclusive. Paretic stroke was defined without clinical evidence of alternative diagnosis. We have examined: age, serum levels of glucose, urea, creatinine, cholesterol, triglycerides, albumin, globulins, ratio albumin/globulins and also a white and red blood-cells count, haemoglobin, erythrocyte sedimentation rate and blood pressure. The routine electrocardiogram (ECG) obtained on admission was examined for atrial fibrillation. The high prevalence of risk factors associated with diabetes mellitus in stroke patients indicate the need for further studies of stroke prevention and treatment particularly in this disease.

[Antibiograms performed on Gram-negative bacteria isolated from urine cultures. Results and considerations]

The authors have isolated 938 Gram-negative germs from 3141 urinocultures. In the work is reported the percentage of sensitivity of the single tested antibiotics and it is recommended an exact therapy, if we won't have clamorous failures.

[Reference values for the serum concentration of apolipoproteins A and B, the A/B ratio and cholesterol-HDL. Evaluation in a clinically healthy population in Amiata (Grosseto)]

The authors have studied the distribution of the Apolipoproteins A and B, the Apo A/B ratio and the HDL-cholesterol on healthy people, according to sex and age, in order to fix the reference values, considering that the literature is poor and the opinions are different.

[Urine culture and antibiogram in 2 different populations (ambulatory and hospitalized). Considerations on 2155 tests performed consecutively]

The authors report a their casuistry on 2155 between urinocultures and cultures of vescical catheters, pointing out an unexpected prevalence of Gram-positive germs and of that point out the possible causes. There are represented also some tables relative to the antibiotics tested for the single germs.