Conservative treatment of a synovial cyst in a golden eagle (Aquila chrysaetos) with triamcinolone acetonide

In human and veterinary medicine, the treatment of synovial cysts involves medical or surgical approach. When medical treatment is chosen, triamcinolone acetonide is one of the most used drugs. In this case, intracystic triamcinolone was administered for the treatment of a non-infectious elbow synovial cyst in a subadult female Golden eagle (Aquila chrysaetos), unable to fly. The bird was brought to a wildlife rescue center after an aerial fight with a conspecific. After the treatment, no clinically detectable adverse effects were noted and there was no recurrence within two weeks. Given the improvement of the clinical conditions and the recovery of flight ability, the animal was released back into the wild 17 days after administration of the drug.

Effects of Intratesticular Lidocaine in Pet Rabbits Undergoing Orchiectomy

The use of local anesthetics for castration is both simple and cost-effective, and it may contribute to reducing the anesthetic requirements. Despite its common use in clinical practice, the literature regarding the effects of intratesticular lidocaine in rabbits is limited. In this study, nine rabbits per group were assigned to intratesticularly receive either 2% lidocaine (0.05 mL/kg into each testicle) or an equivalent volume of saline prior to elective orchiectomy. Anesthesia was induced by intranasal administration of ketamine, medetomidine, and butorphanol. During intraoperative assessment, no significant differences in vital parameters (heart rate, respiratory rate, and peripheral saturation of oxygen) were observed between the groups. However, rabbits receiving intratesticular saline displayed a higher incidence of responses to surgical stimuli. Postoperative pain was evaluated using the composite Centro Animali Non Convenzionali Rabbit Scale (CANCRS), revealing a significantly lower score at the initial post-surgery assessment in rabbits treated with intratesticular lidocaine. All subjects exhibited rapid resumption of food intake and fecal output. While all rabbits demonstrated satisfactory perioperative performances, the use of intratesticular lidocaine was associated with a diminished response to surgical stimuli. Consequently, this practice has the potential to reduce the requirement for additional anesthetics or analgesics, promoting faster recovery.

Molecular Surveillance for Bocaparvoviruses and Bufaviruses in the European Hedgehog (Erinaceus europaeus)

The presence of bocaparvoviruses (BoVs) and bufaviruses (BuVs) in the European hedgehog (Erinaceus europaeus) was investigated by screening duodenal and liver samples collected from 183 carcasses, delivered to wildlife rescue centers located in northwestern Italy. BoV DNA was detected in 15 animals (8.2%), with prevalences of 7.1% (13/183) and 2.7% (5/183) in intestine and liver samples, respectively. Upon the sequence analyses of the NS1 gene, two highly divergent BoVs (65.5-67.8% nt identities) were identified. Fourteen strains showed the highest identity (98.3-99.4% nt) to the hedgehog BoV strains recently detected in China in Amur hedgehogs (Erinaceus amurensis), whilst four strains were genetically related (98.9-99.4% nt identities) to the porcine BoVs identified in pigs and classified in the species Bocaparvovirus ungulate 4, which included related viruses also found in rats, minks, shrews, and mice. BuV DNA was detected in the duodenal samples of two hedgehogs, with a prevalence rate of 1.1%. The nearly full-length genome of two BuV strains, Hedgehog/331DU-2022/ITA and Hedgehog/1278DU/2019/ITA, was reconstructed. Upon phylogenetic analysis based on the NS and VP aa sequences, the Italian hedgehog BuVs tightly clustered with the BuVs recently identified in the Chinese Amur hedgehogs, within a potential novel candidate species of the genus Protoparvovirus.

Seismic assessment of bridges through structural health monitoring: a state-of-the-art review

The present work offers a comprehensive overview of methods related to condition assessment of bridges through Structural Health Monitoring (SHM) procedures, with a particular interest on aspects of seismic assessment. Established techniques pertaining to different levels of the SHM hierarchy, reflecting increasing detail and complexity, are first outlined. A significant portion of this review work is then devoted to the overview of computational intelligence schemes across various aspects of bridge condition assessment, including sensor placement and health tracking. The paper concludes with illustrative examples of two long-span suspension bridges, in which several instrumentation aspects and assessments of seismic response issues are discussed.

Main causes of death of free-ranging bats in Turin province (North-Western Italy): gross and histological findings and emergent virus surveillance

BACKGROUND

Bats are recognized as reservoir species for multiple viruses. However, little is known on bats' health and mortality. Thus, this study aimed to investigate the main causes of death of bats from Turin province (North-western Italy) and to describe gross and histopathological lesions potentially associated with the presence of selected bat viruses.

RESULTS

A total of 71 bats belonging to 9 different species of the families Vespertilionidae and Molossidae were necropsied and samples of the main organs were submitted to histopathological examination. Also, aliquots of the small intestine, liver, spleen, lung, and brain were collected and submitted to biomolecular investigation for the identification of Coronaviridae, Poxviridae, Reoviridae (Mammalian orthoreovirus species), Rhabdoviridae (Vaprio ledantevirus and Lyssavirus species) and Kobuvirus. The majority of bats died from traumatic lesions due to unknown trauma or predation (n = 40/71, 56.3%), followed by emaciation (n = 13/71,18.3%). The main observed gross lesions were patagium and skin lesions (n = 23/71, 32.4%), forelimbs fractures (n = 15/71, 21.1%) and gastric distension (n = 10/71,14.1%). Histologically, the main lesions consisted of lymphoplasmacytic pneumonia (n = 24/71, 33.8%), skin/patagium dermatitis (n = 23/71, 32.4%), liver steatosis and hepatitis (n = 12, 16.9%), and white pulp depletion in the spleen (n = 7/71, 9.8%). Regarding emergent bat viruses, only poxvirus (n = 2, 2.8%) and orthoreovirus (n = 12/71, 16.9%) were detected in a low percentage of bats.

CONCLUSIONS

Trauma is the main lesion observed in bats collected in Turin province (North-western Italy) associated with forelimb fractures and the detected viral positivity rate seems to suggest that they did not represent a threat for human health.

Frustrated Total Internal Reflection Measurement System for Pilot Inceptor Grip Pressure

Sensing the interaction between the pilot and the control inceptors can provide important information about the pilot's activity during flight, potentially enabling the objective measurement of the pilot workload, the application of preventive actions against loss of situational awareness, and the identification of the insurgence of adverse couplings with the vehicle dynamics. This work presents an innovative pressure-sensing device developed to be seamlessly integrated into the grips of conventional aircraft control inceptors. The sensor, based on frustrated total internal reflection of light, is composed of low-cost elements and can be easily manufactured to be applicable to different hand pressure ranges. The characteristics of the sensor are first demonstrated in laboratory calibration tests. Subsequently, applications in flight simulator testing are presented, focusing on the objective representation of the pilot's instantaneous workload.

Intranasal Atomization of Ketamine, Medetomidine and Butorphanol in Pet Rabbits Using a Mucosal Atomization Device

A non-invasive method of drug delivery, intranasal atomization, has shown positive results in human medicine and in some animal species. The objective of this study was to evaluate the effects of intranasal atomization, compared to intramuscular administration, of a mix of anesthetic drugs in pet rabbits. In total, 104 mixed-breed pet rabbits, undergoing various types of surgery, received a combination of ketamine, medetomidine, and butorphanol (20, 0.4, and 0.2 mg/kg) by intranasal atomization using a Mucosal Atomization Device (Group MAD) or intramuscular administration (Group IM). When required, isoflurane was dispensed through a face mask. At the end of the procedures, atipamezole was administered using the same routes in the respective Groups. There were no differences in time to loss of righting reflex between the groups, while differences were found for the need for isoflurane (higher in Group MAD) and recovery time, occurring earlier in Group MAD. The results suggest that intranasal atomization of a combination of ketamine, medetomidine, and butorphanol produces a lighter depth of anesthesia in pet rabbits, compared to intramuscular administration. Intranasal atomization can be performed to administer sedative and anesthetic drugs, avoiding the algic stimulus related to the intramuscular inoculation of drugs.

National taxation on sugar-sweetened beverages: a scoping review and time series analysis

Background

The intake of Sugar-Sweetened Beverages (SSBs) has increased around the world, leading to a growing burden of disease due to these beverages, such as obesity, diabetes, and heart disease. Taxation is a major action for comprehensive programmes aimed at reducing consumption of sugars. For these reasons, the aims of our study were to systematically summarize national tax legislation on SSBs and to assess the impact of these laws on the prevalence of overweight, obesity, and diabetes.

Methods

We conducted a scoping review to summarize the landscape of national tax laws on SSBs implemented worldwide. We included any document reporting both currently into force and past national tax laws addressing SSBs. As to the time series analysis, data regarding the national prevalence of obesity, overweight, and diabetes were retrieved from WHO Global Health Observatory data repository.

Results

As of July 2020, 34 countries worldwide implemented SSB taxation (amount-specific and ad valorem tax design), of which 17 (50.0%) in high-income countries, 12 (35.3%) in upper-middle income countries, and 5 (14.7%) in low-income countries. As for overweight, Hungary was the only country showing a slower rate of change after the taxation. Regarding obesity, France, Guatemala, Hungary and Panama showed a deceleration of the rates of change after the intervention. Eventually, Hungary and Tonga exhibited a one-time decrease of diabetes prevalence at the intervention point. Decelerating rates of change in the post-intervention period was also found for Guatemala and Fiji.

Conclusions

Laws targeting SSBs showed, at least in part, to be an effective measure to reduce the prevalence of overweight, obesity, and diabetes. Less than one fifth of worldwide countries have implemented national taxation policies. Finally, while taxation might be effective to reduce SSB consumption, other types of Public Health interventions, such as educational initiatives, should not be neglected.

Key messages

• Sugar-Sweetened Beverages (SSBs) are associated with obesity, diabetes, and heart disease. Taxation can be an important tool to reduce the consumption of SSBs.

• Prevalence of obesity, overweight and diabetes decreased in countries that adopted taxation. However, other strategies such as educational programs should be implemented to reduce the intake of SSBs.

Impact of COVID-19 on flu vaccination among pregnant women in a Teaching Hospital in Rome

Background

According to WHO, UNICEF, GAVI and the Sabin Vaccine Institute data, the COVID-19 pandemic caused the disruption of routine vaccinations in at least 68 countries. In March ‘20, the WHO published a guide to help countries continuing their provision safely to prevent unnecessary visits and hospitalizations: especially flu vaccination is paramount to reduce respiratory illnesses and their burden on healthcare systems. For the flu season 2021-22, the Italian Ministry of Health recommended prioritizing flu vaccination for pregnant women. This study aims at comparing flu vaccination rates between pre-pandemic and pandemic periods in pregnant women attending a birthing preparation course at the Fondazione Policlinico Universitario A.Gemelli IRCCS (FPG) in Rome.

Methods

A repeated cross-sectional study was carried out in FPG during two flu epidemic seasons (October ‘19-January ‘20 and September ‘20-January ‘21), when two different cycles of birthing preparation courses were held (face-to-face and online, respectively). Pregnant women and their partners attending them were offered flu vaccination at FPG. A χ2 test was performed to compare vaccination rates, with statistical significance set at p = 0.05.

Results

In 2019-20, 48 out of 119 women and 39 men out of 119 attending the course accepted flu vaccination, while in 2020-21 they were respectively 88 out of 317 and 89 out of 317. Overall vaccination compliance among pregnant women was significantly higher in 2019-20 than in 2020-21 (40.3% and 27.8% respectively, p = 0.012), while the difference was not significant among their partners (32.8% and 28.1% respectively, p = 0.337).

Conclusions

The COVID-19 pandemic negatively affected flu vaccination adherence among the pregnant women involved. Fear of contagion and access to facilities closer to their home could be potential key drivers. These results represent an important warning on flu vaccination attitudes during the pandemic: more actions are needed to improve compliance.

Key messages

• COVID-19 might have hindered access to immunization services for at-risk populations, such as that of pregnant women.

• From a Public Health point of view, more actions are needed to harmonize interactions between hospitals and local national health services to improve vaccination compliance.

Successful Treatment of Pyometra Caused by Pseudomonas aeruginosa Infection in a Rabbit

This article reports an unusual presentation of pyometra in a pet rabbit. A 2-year-old mixed-breed female rabbit with pelvic limb paralysis was referred for abdominal distension associated with prolonged depression and decreased appetite. Clinical examination and diagnostic imaging (radiographs and ultrasound) led to the provisional diagnosis of pyometra that was caused by the presence of an enlarged organ containing fluid material and occupying most of the caudal abdomen. Exploratory laparotomy was performed under general anesthesia. After abdominal wall incision along the linea alba, the uterus was immediately evident and the uterine wall was over-distended and damaged, with purulent material free in the abdominal cavity. Ovariohysterectomy was performed and uterine wall samples were sent for microbiological examination and antimicrobial susceptibility testing. The agent causing the pyometra was found to be Pseudomonas aeruginosa, which was resistant to enrofloxacin and ceftazidime. This is the first report of pyometra caused by P. aeruginosa in a pet rabbit, based on a literature search. Furthermore, a peculiarity of the present case is the occurrence of pyometra in a rabbit with no history of mating or parturition.

Understanding COVID-19 nonlinear multi-scale dynamic spreading in Italy

The outbreak of COVID-19 in Italy took place in Lombardia, a densely populated and highly industrialized northern region, and spread across the northern and central part of Italy according to quite different temporal and spatial patterns. In this work, a multi-scale territorial analysis of the pandemic is carried out using various models and data-driven approaches. Specifically, a logistic regression is employed to capture the evolution of the total positive cases in each region and throughout Italy, and an enhanced version of a SIR-type model is tuned to fit the different territorial epidemic dynamics via a differential evolution algorithm. Hierarchical clustering and multidimensional analysis are further exploited to reveal the similarities/dissimilarities of the remarkably different geographical epidemic developments. The combination of parametric identifications and multi-scale data-driven analyses paves the way toward a closer understanding of the nonlinear, spatially nonuniform epidemic spreading in Italy.

Vaccination attitude assessment among attendees the birthing preparation course: a pre-post study

Background

Vaccinations are among the most effective and safe ways to prevent the spreading and the complications of infectious diseases. In order to reduce risks and to protect children from the early beginning of their life, most vaccinations are recommended within the 15th month of life. In Italy, the law provides 10 compulsory vaccinations to the 0-16 age group. A training program was carried on by a Public Health specialist during the birthing preparation course, aimed at increasing the attitude to vaccination in maternal-child age.

Methods

A training session in the birthing preparation course was specifically carried out to raise awareness about vaccination during both pregnancy and puerperium and in early childhood; a questionnaire on vaccination awareness was administered before and after the training session.

Results

Out of 119 pregnant women attended the birthing preparation course from October 2019 to January 2020. As a result of the interventions, the percentage of the participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% pre-intervention to 64.56% post-intervention (p < 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get, out of the 12 vaccinations proposed in the questionnaire: 9.68/12 pre-intervention versus 10.57/12 post-intervention (p = 0.021). Participants supporting the mandatory vaccinations are 96.04% pre-intervention and rise to 98.73% post-intervention.

Conclusions

Attitude and knowledge related to vaccination are crucial values for maternal-child health: they significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, labor and childbirth, according the life-course approach to health, from the Public Health perspective.

Key messages

The childbirth preparation courses for pregnant should be valuable as a precious opportunity to raise parents’ awareness and their attitude to vaccinations, if dedicated sessions are included in them. The mandatory nature of vaccines is very well received by pregnant women.

Reliability and construct validity of a composite pain scale for rabbit (CANCRS) in a clinical environment

A composite pain scale for assessing and quantifying pain in rabbits (CANCRS) has been designed merging the Rabbit Grimace Scale (RbtGS) and a scale including clinical parameters (CPS). Construct validity and inter-rater reliability were assessed for CANCRS, for RbtGS and for CPS, in order to test their potential to detect pain in a clinical setting. Rabbits (n = 116) were either hybrids or purebreds and they were independently evaluated by two raters, who could be veterinarians (V) or veterinary medicine students (S). Score intervals determined four pain classes (No pain, Discomfort, Moderate pain and Severe pain) that matched presumptive pain classes associated with some pathological conditions. A chi-square test was used to assess the construct validity of the scales by checking how frequently scale results and presumptive pain classes matched. Sixty-nine patients were evaluated by one V and one S, whereas forty-seven rabbits were assessed by two V, in order to test inter-rater reliability. An intra-class correlation coefficient (ICC) was used to test reliability of the scales, whereas Cohen’s kappa tested inter-rater agreement for each parameter of the CANCRS. Construct validity results show that CANCRS and RbtGS efficiently reveal pain (P ≤ 0.05), while CPS does not (p > 0.05). Inter-rater reliability was very good for both CANCRS and CPS (ICC 0.88 V-V, 0.94 between V-S; ICC 0.97 V-V, 0.91 V-S) and good for RbtGS (ICC 0.77 V-V, 0.88 V-S); therefore, CPS reproducibility was better between veterinarians and students than between veterinarians. Inter-rater agreement between veterinarians and veterinary medicine students was moderate to very good for all the parameters included in the CANCRS (Cohen’s kappa >0,60). In conclusion, it is possible to state that the CANCRS has construct validity and it is a reliable tool for use in clinical practice, when coping with many rabbits with morphological differences. It is easy and fast to use and enriches the RbtGS with some clinical parameters that should be monitored during any clinical examination, allowing for capture of the multidimensional aspect of pain.

Laboratory handling practice for faecal microbiota transplantation

AIMS

Faecal microbiota transplantation (FMT) consists of the infusion of faeces from a healthy donor to the gastrointestinal tract of a recipient patient to treat disease associated with alterations in gut microbiota. The objective of this article was to describe laboratory workflow of an FMT laboratory to provide tips for preparing the faecal suspensions to be infused.

METHODS AND RESULTS

Twenty-stool solutions obtained from ten donors were prepared using two different protocols: magnet plate emulsion (MPE) and Seward Stomacher^TM Emulsion (SSE). We evaluated parameters such as preparation time, handiness, and aerobic and anaerobic microbial count. For three donors, we monitored bacterial counts after defrosting at different time-points. MPE requires more time than SSE. In terms of microbial load, both methods showed similar values, with small and statistically differences (P ≤ 0·05) regarding anaerobes in favour of SSE. Frozen aliquots showed the same bacterial load values after defrosting.

CONCLUSION

Although both methods allow an easy and available preparation of a stool suspension, SSE seems more suitable, particularly for stool banking. Aerobic and anaerobic species are preserved with both protocols; and safety for laboratory operators is guaranteed.

SIGNIFICANCE AND IMPACT OF THE STUDY

In recent years, FMT has become a fascinating and interesting subject. Nevertheless, there are no real guidelines describing laboratory facilities and procedures. This paper aims to be a useful and simple guide to increase the number FMT centres as much possible.

Bilateral Pentadactyly in an Immature Alpine Swift (Tachymarptis melba)

An immature Alpine swift (Tachymarptis melba) that presented to a wildlife rehabilitation center was observed to have bilateral pentadactyly on examination. The supernumerary digits did not appear to cause discomfort for the bird, and no motor deficits were apparent. The skin and nails of the digits appeared normal. Radiographically, the extra digits appeared to be composed of two phalanges. The male swift was housed and fed an insectivore diet until it was fully fledged and demonstrated good flying ability. After 16 days of hospitalization, hand-feeding, and flight training, the bird was released to the wild. To our knowledge, this is the first case described of bilateral pentadactyly in an Alpine swift.

Randomised clinical trial: faecal microbiota transplantation by colonoscopy plus vancomycin for the treatment of severe refractory Clostridium difficile infection-single versus multiple infusions

BACKGROUND

Faecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridium difficile infection. Far less evidence exists on the efficacy of FMT in treating severe Clostridium difficile infection refractory to antibiotics.

AIM

To compare the efficacy of two FMT-based protocols associated with vancomycin in curing subjects with severe Clostridium difficile infection refractory to antibiotics.

METHODS

Subjects with severe Clostridium difficile infection refractory to antibiotics were randomly assigned to one of the two following treatment arms: (1) FMT-S, including a single faecal infusion via colonoscopy followed by a 14-day vancomycin course, (2) FMT-M, including multiple faecal infusions plus a 14-day vancomycin course. In the FMT-M group, all subjects received at least two infusions, while those with pseudomembranous colitis underwent further infusions until the disappearance of pseudomembranes. The primary outcome was the cure of refractory severe Clostridium difficile infection.

RESULTS

Fifty six subjects, 28 in each treatment arm, were enrolled. Twenty one patients in the FMT-S group and 28 patients in the FMT-M group were cured (75% vs 100%, respectively, both in per protocol and intention-to-treat analyses; P = 0.01). No serious adverse events associated with any of the two treatment protocols were observed.

CONCLUSIONS

A pseudomembrane-driven FMT protocol consisting of multiple faecal infusions and concomitant vancomycin was significantly more effective than a single faecal transplant followed by vancomycin in curing severe Clostridium difficile infection refractory to antibiotics. Clinical-Trials.gov registration number: NCT03427229.

Comparison of different methods of semen cryopreservation in Melopsittacus undulatus

Melopsittacus undulatus is largely used as a potential model for assisted reproduction in other endangered parrot species. Semen was collected from nineteen healthy adult males, by massage technique, during the breeding season. After preliminary evaluations through CASA analysis, eight birds were selected as semen donors and five ejaculates of each bird were utilized to evaluate the effect of 10% ethylene glycol (EG) addition, in two times, during 40min of equilibration time at 4°C, and to compare two programmable freezing curves (a rapid and a slow temperature descent rate) and freezing on nitrogen vapors. Diluted semen (modified TALP, pH 8.4) was divided into two aliquots, the first for freezing individual samples, the second to be mixed in a semen pool from the eight birds. Potential inseminating doses of 10μl, containing 1×10⁶ spermatozoa, were frozen. The effect of EG addition on semen motility and kinetic parameters was analyzed and the three freezing methods were compared. EG addition caused a significant decline of semen motility in individual samples, not in semen pools. The three freezing curves resulted in significant differences in thawed-semen parameters, with nitrogen vapors showing the worst results, while the higher total and progressive motility values were obtained with the 'fast' protocol. Thawed-semen pools motility and kinetic parameters appeared lower than those of the individual ejaculates. The differences found between single ejaculates and semen pools emphasize the importance of performing artificial insemination tests in order to assess the in vivo performance of single ejaculates in the parrot species.

Comparison of celioscopy and histological examinations to assess male gonadal health and functionality in adults and immature wild raptors

Celioscopy is routinely used in birds for sex determination and diagnostic purposes. Aim of this work was to validate celioscopy for the assessment of male gonads functionality in wild raptors, comparing the results of direct observation with morphometrical and histological characteristics. The work was done at the 'Centro Animali Non Convenzionali' of the University of Turin, Italy, on 31 endoscopically evaluated raptors that died or were euthanized. Through celioscopic observation, the birds were classified in adults or immatures and maturity categories were defined according to the adrenal-gonad size ratio and to the degree of blood filling of testicular vessels. The gonads were removed immediately after death/euthanasia and measured. Albuginea tunic thickness, diameter of seminiferous tubules, number of meiosis figures, tubular development degree, tubular degeneration degree and germinal cells production degree were evaluated. Testicular size tended to increase from immature to adult birds and from 'out of' to 'in' breeding season; albuginea tunic thickness tended to be higher out of the reproductive season while diameter of the seminiferous tubules, germinative epithelium thickness and number of meiosis figures were higher in the breeding season. In season adults generally showed higher values in tubular development and germinal cells production, and lower degrees of tubular cells degeneration and fibrosis. From the interpretation of all the morphometrical and histological aspects, a general reproductive degree of activity was given to the birds and compared with celioscopic results. A perfect concordance was found in 23 out of 31 cases and a good concordance in six ones; histology could describe obviously better sub-clinical conditions undetectable at direct observation. These preliminary results suggest that celioscopy could be a useful tool to assess male gonads functionality in wild raptors, with the future goal to select the better potential semen donors.

Semen Collection and Spermatozoa Characteristics in the Kea Parrot (Nestor notabilis)

We describe the seminal characteristics of the kea parrot (Nestor notabilis), an endangered species endemic to the South Island of New Zealand. Semen was collected in the full breeding season from 6 birds in the collection of an amateur aviculturist. The manual massage technique was used. A total of 25 ejaculates was collected and evaluated for volume, degree of contamination, and spermatozoa concentration; motility and kinetic parameters were assessed on diluted samples (modified Tyrode's Albumin Lactate Pyruvate, pH 8.2, temperature 37.5°C) with a computer-aided sperm analyzer. Four ejaculates were not analyzed because of an excessively high degree of contamination. Semen color ranged from transparent or turbid yellow to whitish. The geometric mean of spermatozoa number/ejaculate was 765.9 ± 2084.7 × 10⁶. Total and progressive motility were 71.7% ± 20.0% and 59.8% ± 22.0%, respectively. Great variability was observed both among birds and among different ejaculates of the same subject. The seminal characteristics of kea are worth further investigation, with the aim of relating semen quality to fertility and defining a minimum inseminating dose for breeding purposes. A deeper knowledge of male reproductive biology also can increase the success of breeding programs and enable the use of the kea as a model species for other more threatened species, such as the kaka ( Nestor meridionalis ) and the kakapo (Strigops habroptila).

Predictors of failure after single faecal microbiota transplantation in patients with recurrent Clostridium difficile infection: results from a 3-year, single-centre cohort study

OBJECTIVES

Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (CDI). Although a single faecal infusion is usually sufficient to eradicate CDI, a considerable number of patients need multiple infusions to be cured. The aim of this study was to identify predictors of failure after single faecal infusion in patients with recurrent CDI.

METHODS

We included patients with recurrent CDI prospectively treated with FMT by colonoscopy. By means of univariate and multivariate analysis, variables including female gender, age, number of CDI recurrences, severity of CDI, hospitalization, inadequate bowel preparation, unrelated donor, and use of frozen faeces, were assessed to predict failure after single faecal infusion.

RESULTS

Sixty-four patients (39 women; mean age 74 years) were included. Of them, 44 (69%) were cured by a single faecal infusion, whereas 20 (31%) needed repeat infusions. Overall, FMT cured 62 of 64 (97%) patients. In the subgroup of patients with severe CDI, only eight of 26 (30%) were cured with a single infusion. At multivariate analysis, severe CDI (OR 24.66; 95% CI 4.44-242.08; p 0.001) and inadequate bowel preparation (OR 11.53; 95% CI 1.71-115.51; p 0.019) were found to be independent predictors of failure after single faecal infusion.

CONCLUSIONS

Severe CDI and inadequate bowel preparation appear to be independent predictors of failure after single faecal infusion in patients treated with FMT by colonoscopy for recurrent CDI. Our results may help to optimize protocols and outcomes of FMT in patients with recurrent CDI.

Knowledge, attitudes and behaviors of the Italian population towards Neisseria meningitidis, Streptococcus pneumoniae and HPV diseases and vaccinations: A cross-sectional multicentre study

OBJECTIVES

This study addressed knowledge of Streptococcus pneumoniae, Neisseria meningitidis and human papillomavirus (HPV), and attitudes and behaviours towards vaccines against them.

STUDY DESIGN

This is a cross-sectional, multicentre study.

METHODS

Data were collected through a questionnaire administered to 530 adults who accessed four Departments of Prevention of the Italian National Health Service in 2013.

RESULTS

Less than 50% of people gave the right answer to all the questions concerning the three diseases, but 96.2%, 94% and 92.7% agreed with the importance of vaccination against N. meningitidis, S. pneumoniae and HPV, respectively, and 58.4% expressed own willingness to have their children vaccinated with N. meningitidis B vaccine. The attitude towards vaccination was more positive in women for N. meningitidis and in people having children for HPV. Furthermore, individuals giving correct answers to all knowledge items were more in favour of both HPV and S. pneumoniae vaccination. A total of 68.8%, 82.6% and 84.5% of respondents vaccinated their own children against N. meningitidis C, S. pneumoniae and HPV, respectively. About 50% of the respondents reported paediatricians' or other health professionals' recommendations as the main reason for vaccination.

CONCLUSIONS

Vaccinations may be promoted through actions aimed at increasing citizens' knowledge. Health professionals should be educated to actively provide information on vaccinations in a clear, comprehensive and effective way.

Priapism Following hCG Administration In A Cat

Priapism, defined as a persistent and painful penile erection in the absence of sexual excitation, is an uncommon disorder of cats that usually requires penile amputation and perineal urethrostomy. This report describes a case of priapism in a short-haired Persian male cat aged 3 years. The condition had appeared after attempted mating with a female at the end of oestrus and the time of referral to the authors was 10 days after onset. Previous treatment had consisted of corticosteroids and local lubricants. On physical examination, the cat appeared bright and alert; the penis was erect but the colour was normal; blood analysis excluded viral pathologies. The cat history revealed that he had been treated with 500 IU hCG i.m. because he had to mate with three queens in a short period of time. In consideration of the mild symptoms, conservative treatment was adopted. The condition resolved in about 40 days. This is the first report of priapism following hCG administration in a cat and indicates that the misuse of this gonadotropin might cause potentially harmful side effects.

Systematic review of studies investigating the association between dietary habits and cutaneous malignant melanoma

OBJECTIVE

Several papers have dealt with diet as a risk factor for cutaneous malignant melanoma (CMM). This study aimed to synthesize available data on the topic.

STUDY DESIGN

A systematic review of observational studies assessing the association between dietary habits and CMM was performed.

METHODS

Electronic databases were used to identify eligible articles. Quality was assessed through the Newcastle-Ottawa scale. Case-control and cohort studies evaluating the intake of food/nutrients through the assessment of dietary habits and the occurrence of CMM were considered eligible. Data comparing the highest and lowest levels of consumption were collected from single studies and described qualitatively as data combination was not possible. Results were reported as percentages on the basis of relative risks and odds ratios.

RESULTS

Eighteen studies reported in 21 articles were selected. Cohort studies showed better quality than case-control studies. Most articles did not detect any significant association between food/nutrient intake and CMM, except for limited evidence of a protective role associated with fish, vegetables and fruit. Risk reduction was shown to be 35-37%, 40-57% and 34-46%, respectively, in studies reporting significant results. Similarly, few articles showed protective roles of beta-carotene and vitamins A, C, D and E, with risk reduction of 64%, 37-43%, 41%, 15-39% and 50-66%, respectively.

CONCLUSION

A trend towards reduced risk of CMM associated with higher intake of fish, vegetables and fruit, as well as beta-carotene and vitamins A, C, D and E, has been shown but further research is needed to provide decisive data.

General medical conditions in 347 bipolar disorder patients: clinical correlates of metabolic and autoimmune-allergic diseases

BACKGROUND

Patients with bipolar disorder (BD) suffer from greater physical morbidity and mortality than the general population. The aim of the present study is to explore the prevalence and clinical correlates of General Medical Conditions (GMC) in a large consecutive sample of patients with BD.

METHOD

The study sample comprised of 347 patients who met DSM-IV-TR criteria for BD I (n=207, 59.7%), BD II or Cyclothymic Disorder (n=140, 40.3). Diagnostic information was collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders- Clinical Version (SCID-I), and information about personal and family history were collected by the Semi-Structured Interview for Mood Disorder-Revised (SIMD-R). Standardized procedure was used to assess the diagnosis of GMC, which was considered present only if a specific therapy to treat the condition was prescribed by a specialist or a general practitioner. In order to explore possible relationships between physical comorbidity and clinical features of BD, we compared patients with (MD) and without (No-MD) Metabolic Diseases (MD) and patients with (AAD) and without (No-AAD) Autoimmune-Allergic Diseases (AAD).

RESULTS

The most commonly reported GMCs were: Headache, Hypercholesterolemia (>200mg/dl), Chronic Constipation, Obesity, Arterial Hypertension (BP >140/90 mmHg), Hypothyroidism, Allergic Rhino-Conjunctivitis, Irritable Bowel Syndrome, Hypertriglyceridemia (>150 mg/dl), Metabolic Syndrome, Hiatus Hernia, Dysmenorrhea, Urticaria, Atopic Dermatitis, Psoriasis, Seborrheic Dermatitis, Diabetes Mellitus, Bronchial Asthma, Cardiac Arrhythmias, Biliary Lithiasis, and COPD. In our sample, MD (n=148, 42.7%) and AAD (n=167, 48.1%) were the most common categories of GMCs. Interestingly, the lifetime prevalence of cancer and neoplastic diseases was very low: 1 patient (.3%) reported Lung Adenocarcinoma and 2 (.6%) patients Bowel Cancer. In the group comparisons, length of pharmacological treatment (OR=1.054; 95% CI=1.030-1.078), age at onset of first major episode (OR=1.043; 95% CI=1.019-1.067), length of the current episode (OR=1.025; 95% CI=1.020-1.533) and absence of lifetime comorbid substance abuse (OR=.373; 95% CI=.141-.989) were statistically associated with the presence of comorbid MD; while only AD-induced hypomania (OR=1.62; 95% CI=1.011-2.597), and cyclothymic temperament (OR=1.051; 95% CI=1.016-1.087) were statistically associated with the presence of comorbid AAD.

LIMITATIONS

Possible referral and selection bias; retrospective, non-blind, cross-sectional evaluation.

CONCLUSION

MD and AAD were highly represented in our sample, while cancer and neoplastic diseases were uncommon. The clinical correlates of different sub-groups of GMC suggest different interpretations. The presence of MD seems to be correlated with the progression of BD and the chronic medication exposure, while comorbid AAD seems to correlate with a specific clinical subtype of BD, characterized by mood reactivity and temperamental mood instability. If the link with autoimmune-allergic diathesis will be confirmed, it could provide an interesting new paradigm for the study of the "systemic" nature of mood disorders and a promising target for future treatment options.

The significance of mixed states in depression and mania

The DSM-5 definition of mixed features "specifier" of manic, hypomanic and major depressive episodes captures sub-syndromal non-overlapping symptoms of the opposite pole, experienced in bipolar (I, II, and not otherwise specified) and major depressive disorders. This combinatory model seems to be more appropriate for less severe forms of mixed state, in which mood symptoms are prominent and clearly identifiable. Sub-syndromal depressive symptoms have been frequently reported to co-occur during mania. Similarly, manic or hypomanic symptoms during depression resulted common, dimensionally distributed, and recurrent. The presence of mixed features has been associated with a worse clinical course and high rates of comorbidities including anxiety, personality, alcohol and substance use disorders and head trauma or other neurological problems. Finally, mixed states represent a major therapeutic challenge, especially when you consider that these forms tend to have a less favorable response to drug treatments and require a more complex approach than non-mixed forms.

The life cycle impact assessment applied to the Domingo Rubio tidal system by the study of seasonal variations of the aquatic eutrophication potential

The innovative technique of Life Cycle Impact Assessment (LCIA) applied to dynamic environmental systems has been recently developed. In this work we investigate a complex system, the Domingo Rubio tideland (Huelva, Spain), where a tidal marsh and a continental lagoon converge. This wetland, catalogued as Natural Park by the Andalusia government, is subjected to a high eutrophicant pressures related to the strawberry culture and the inputs coming from industrial wastes. NO(2)(-), NO(3)(-) and PO(4)(3-) were analyzed in 41 water samples, obtaining values up to 100mg L(-1) Σ(NO(2)(-), NO(3)(-)) and 18.5mg L(-1) PO(4)(3-). All these values exceed the accepted levels by the European Environment Agency. N/P ratios and the Aquatic Eutrophication Potentials (AEP) for N and P showed a constant imbalance of the system. During one tidal cycle, the tidal channel can have both N and P as limiting nutrient (P is the limiting nutrient during low tide and N is during high tide) and there exists an alternation of AEP domination too between N and P in the continental area, what points to an excess of both nutrients all over the study area, and to the necessity of diminishing the nutrient inputs and a higher control on these pollution sources as well.

Prospective 3-year surveillance for nosocomial and environmental Legionella pneumophila: implications for infection control

OBJECTIVES

To perform a 3-year, prospective surveillance program for legionnaires disease (LD) in a large university hospital in Rome, and to assess the usefulness of the hospital water monitoring program in predicting the risk of nosocomial LD.

METHODS

Samples from patients with new cases of nosocomial pneumonia were sent for legionella laboratory investigations. Meanwhile, water samples for bacteriological analysis were collected every 6 months from high- and medium-risk hospital wards (10 in total). Legionella pneumophila isolates collected were serotyped and analyzed by pulsed-field gel electrophoresis.

RESULTS

From June 2001 through May 2004, the pneumonia surveillance identified one case of nosocomial LD among 43 cases of nosocomial pneumonia (2.3%). Environmental investigations detected L. pneumophila in 12 (18.7%) of the 64 water samples, of which 50% belonged to serogroup 1. The L. pneumophila count and the percentage of positive locations never exceeded 10(2) colony-forming units/L and 20%, respectively, except when the LD nosocomial case occurred (positive water samples, 40%; L. pneumophila count, <10(2) colony-forming units/L). Genotyping showed 3 prevalent clones of L. pneumophila in the water distribution network, of which one persisted over the 3 years. One clone contained 3 different L. pneumophila serogroups (2, 4, and 6).

CONCLUSIONS

The low incidence of nosocomial cases of LD appears to be associated with a low percentage (<20%) of positive water samples per semester and with a low contamination level (<10(2) colony-forming units/L). An infection control system for nosocomial LD should, therefore, be based on both environmental and clinical surveillance, together with the appropriate maintenance of the hospital water distribution system.

[The discharge form: advantages and limits legionellosis cases individuation]

Despite legionellosis surveillance is active in Italy since many years, the disease notification appears still undervalued. A multicentric survey was carried out among 5 big Italian hospitals. It examined 11,435 discharge forms (1999-2001), reporting pneumonia diagnosis. Legionellosis (II class of notify system for infectious disease) was studied among pneumonia diagnosis by discharge forms. According to the ICD9-CM, there's no specific code for legionellosis (this disease is included among "others gram-negative pneumonia"). So the presumed pneumonia imputable to Legionella spp were the 2.7% of the whole number of analyzed discharge forms. Besides, the data regarding the other pneumonia showed that the etiological agent was specified only in the 11.2% of the case. This situation could be rectified both introducing adequate discharge forms codes and promoting the etiological diagnosis during the hospital stay.

[Environmental diffusion of Legionella spp and legionellosis frequency among patients with pneumonia: preliminary results of a multicentric Italian survey]

A multicentric Italian investigation on legionnaires' disease is in course to clarify host factors as well as pathogen associated characteristics involved in the infection/disease. The main goal of the research plan is to account for some critical aspects concerning identification and prevention of legionellosis. To improve knowledge on factors associated with Legionella spp colonisation in hot waters, to detect cases and to characterize risk factors in subjects which develop pneumonia are specific objectives of the research programme. Preliminary results show that hot waters of houses and hotels are frequently contaminated (22.6% and 54.6%, respectively), mainly by L. pneumophila. Microbial concentrations were low in domestic waters (<1.000 ufc/l), but higher in samples from the hotels (geom. mean 1.85 x 10(3) ufc/l). Warming system, age of the plant, type of building were risk factors significantly associated with Legionella spp positivity. The active surveillance on patients affected by pneumonia with search for Legionella urinary antigen allowed the identification of 34 cases, 3 of which of nosocomial origin, corresponding to 4.2% of the screened pneumonia. After informed consent, 26 subjects were recruited for a case-control-study to clarify risk factors for the disease.

[Efficacy and critical implications of food handlers' professional training: analysis of an experience]

Our study aimed at both assessing the efficacy of the same training course in different contexts and training course repeated in the same context. We examined the most critical aspects, on which to develop further aimed course. In 1998 the Laboratory of Environmental Microbiology of the Institute of Hygiene (UCSC) has implemented 2 professional training courses both for food handlers of a refectory (course A) and of a hospital canteen (course B). Two years after a following course (C) in the hospital canteen. At the beginning and at the end of every course a questionnaire of 25 questions has been gathered in five areas. The data drawn by the questionnaires have been compared using the percentage of exact answers before and after the course. Correct answers beginning and end course: A 89% and 94%, B 68% and 77%, C 76% and 78%. The correct answers beginning course C and end course B are not significatively different (p = 0.1963). Critical areas of the C and B courses have been "microbiological risks" and "correct temperatures"; at the end of the training both the areas had sensitive improvements (C 40% to 59%, 60% to 78%-B 31% to 69%, 45% to 78%).

CONCLUSION

Food handlers professional training have been effective both in the same context and in a different context; the training should be based on both the operator's knowledge and difficulties met during the training; knowledge obtained by training is kept unchanged for some years, and it is supposed to repeat the course after one or two years; the analysis of the areas has confirmed the existence of critical problems, common causes of epidemics in collective catering services.

[The absence of a procoagulant effect after TNK-t-PA: a comparison with streptokinase and rt-PA]

A limitation of current fibrinolytic drugs is the procoagulant activity induced by their administration. TNK is a mutant of tissue plasminogen activator (t-PA) with high fibrin specificity, resistance to plasminogen activator inhibitor-1 and slow plasma clearance, which is administered in a single intravenous bolus. In this study we investigated the procoagulant effect of TNK-t-PA compared to streptokinase, rt-PA or no thrombolysis. Twenty-nine patients with acute myocardial infarction, treated within 6 hours of symptom onset with 1.5 MU streptokinase over 1 hour (n = 12), 100 mg rt-PA in 1.5 hours (n = 12) or 30-40 mg TNK-t-PA in 15 s (n = 5), were studied and compared to 7 patients with contraindications to thrombolysis (control group). All patients received a similar i.v. heparin regimen for at least 24 hours. Blood samples were drawn before the start of treatment (time 0) and after 2 hours. Thrombin formation was assessed as plasma concentrations of thrombin-antithrombin complex (TAT). The four patient groups did not differ significantly in age, sex, time to treatment, infarct location, and TAT values at time 0 (mean value +/- standard error of the mean 9 +/- 2 micrograms/l). Mean TAT levels at 2 hours were 26 +/- 6 micrograms/l in streptokinase treated patients (p = 0.005 vs time 0), 21 +/- 4 micrograms/l in rt-PA treated patients (p < 0.05 vs time 0), 5 +/- 0.6 micrograms/l in TNK treated patients, and 4 +/- 0.4 micrograms/l in controls (NS vs time 0 for TNK and controls). In conclusion, our data suggest that, in patients with acute myocardial infarction, bolus TNK-t-PA, unlike streptokinase or rt-PA infusions, is devoid of procoagulant effects, evaluated 2 hours after its administration.

Incremental prognostic value of serum levels of troponin T and C-reactive protein on admission in patients with unstable angina pectoris

Management of unstable angina is largely determined by symptoms, yet some symptomatic patients stabilize, whereas others develop myocardial infarction after waning of symptoms. Therefore, markers of short-term risk, available on admission, are needed. The value of 4 prognostic indicators available on admission (pain in the last 24 hours, electrocardiogram [ECG], troponin T, and C-reactive protein [CRP]), and of Holter monitoring available during the subsequent 24 hours was analyzed in 102 patients with Braunwald class IIIB unstable angina hospitalized in 4 centers. The patients were divided into 3 groups: group 1, 27 with pain during the last 24 hours and ischemic electrocardiographic changes; group 2, 45 with pain or electrocardiographic changes; group 3, 30 with neither pain nor electrocardiographic changes. Troponin T, CRP, ECG on admission, and Holter monitoring were analyzed blindly in the core laboratory. Fifteen patients developed myocardial infarction: 22% in group 1, 13% in group 2, and 10% in group 3. Twenty-eight patients underwent revascularization: 37% in group 1, 35% in group 2, and 7% in group 2 (p <0.01 between groups 1 or 2 vs group 3). Myocardial infarction was more frequent in patients with elevated troponin T (50% vs 9%, p=0.001) and elevated CRP (24% vs 4%, p= 0.01). Positive troponin T or CRP identified all myocardial infarctions in group 3. Only 1 of 46 patients with negative troponin T and CRP developed myocardial infarction. Among the indicators available on admission, multivariate analysis showed that troponin T (p=0.02) and CRP (p=0.04) were independently associated with myocardial infarction. Troponin T had the highest specificity (92%), and CRP the highest sensitivity (87%). Positive results on Holter monitoring were also associated with myocardial infarction (p=0.003), but when added to troponin T and CRP, increased specificity and positive predictive value by only 3%. Thus, in patients with class IIIB unstable angina, among data potentially available on admission, serum levels of troponin T and CRP have a significantly greater prognostic accuracy than symptoms and ECGs. Holter monitoring, available 24 hours later, adds no significant information.

[Clinical presentation of unstable angina may influence the formation of thrombin during spontaneous episodes of ischemia]

In order to evaluate whether different clinical presentations of unstable angina are associated with a different degree or pattern of activation of the hemostatic, fibrinolytic and inflammatory systems, we measured plasma levels of thrombin-antithrombin III, plasmin-alpha2- antiplasmin complexes and C-reactive protein, as markers of activation of coagulation, fibrinolysis and inflammation respectively, in two groups of patients: 7 patients with de novo unstable angina (Group 1) and 7 patients with destabilizing unstable angina (Group 2). Blood samples were taken on admission for measuring levels of C-reactive protein and during ischemic episodes at the onset of ECG changes and pain (0 min) and after 5, 15 and 60 min in order to assess the peak values of thrombin-antithrombin III and plasmin-alpha2-antiplasmin during the episode. Thrombin-antithrombin III levels in Group 1 were 1.8 microgram/l (0.3-4.15) at 0 min and increased to 17 micrograms/l (2.8-60) after 5 to 15 min (p = 0.013); conversely thrombin-antithrombin III levels in Group 2 were 2.15 microgram/l (1.4-3.8) at 0 min and raised to 4 micrograms/l (2-43) after 5 to 15 min (NS). No significant differences in both groups were observed in plasmin-alpha2-antiplasmin levels (Group 1:650 micrograms/l, ranged 492-956, at 0 min vs 670 microgram/l, range 415-977, at peak; Group 2: 480 micrograms/l, range 274-955, at 0 min vs 502 micrograms/l, range 304-1027, at peak; NS). Inversely, C-reactive protein levels on admission were 4 mg/dl (range 2-27) in Group 1, and 1 mg/dl (range 0.6-4) in Group 2 (p = 0.006). In conclusion, patients with de novo unstable angina have significantly enhanced thrombin (but not plasmin) production during spontaneous ischemic episodes than patients with destabilizing unstable angina. Furthermore, patients with de novo unstable angina have enhanced acute phase responses than patients with destabilizing unstable angina. Our data suggest that different pathogenetic mechanisms may be responsible for acute ischemic episodes in unstable angina and may explain different response to antithrombotic therapy in unstable angina patients.

Differential suppression of thromboxane biosynthesis by indobufen and aspirin in patients with unstable angina

BACKGROUND

We have previously reported aspirin failure in suppressing enhanced thromboxane (TX) biosynthesis in a subset of episodes of platelet activation during the acute phase of unstable angina. The recent discovery of a second prostaglandin H synthase (PGHS-2), inducible in response to inflammatory or mitogenic stimuli, prompted us to reexamine TXA2 biosynthesis in unstable angina as modified by two cyclooxygenase inhibitors differentially affecting PGHS-2 despite a comparable impact on platelet PGHS-1.

METHODS AND RESULTS

We randomized 20 patients (15 men and 5 women aged 59+/-10 years) with unstable angina to short-term treatment with aspirin (320 mg/d) or indobufen (200 mg BID) and collected 6 to 18 consecutive urine samples. Urinary 11-dehydro-TXB2 was extracted and measured by a previously validated radioimmunoassay as a reflection of in vivo TXA2 biosynthesis. Metabolite excretion averaged 102 pg/mg creatinine (median value; n=76) in the aspirin group and 55 pg/mg creatinine (median value; n=99) in the indobufen group (P<.001). There were 16 samples (21%) with 11-dehydro-TXB2 excretion >200 pg/mg creatinine among patients treated with aspirin versus 6 such samples (6%) among those treated with indobufen (P<.001). In vitro and ex vivo studies in healthy subjects demonstrated the capacity of indobufen to largely suppress monocyte PGHS-2 activity at therapeutic plasma concentrations. In contrast, aspirin could only inhibit monocyte PGHS-2 transiently at very high concentrations.

CONCLUSIONS

We conclude that in unstable angina, episodes of aspirin-insensitive TXA2 biosynthesis may reflect extraplatelet sources, possibly expressing the inducible PGHS in response to a local inflammatory milieu, and a selective PGHS-2 inhibitor would be an ideal tool to test the clinical relevance of this novel pathway of arachidonic acid metabolism in this setting.

Usefulness of the addition of heart rate variability to Holter monitoring in predicting in-hospital cardiac events in patients with unstable angina pectoris

Transient ischemia on Holter monitoring is a major determinant of outcome in unstable angina. In this study we investigated whether analysis of heart rate variability (HRV) may further improve the prognostic yield of Holter monitoring in this clinical setting. We performed 24-hour Holter monitoring in 75 patients with unstable angina (59 men, aged 62 +/- 9 years) within 12 hours of hospital admission. Number and duration of myocardial ischemic episodes, and both time domain and frequency domain HRV measures were obtained from Holter recordings. In-hospital major cardiac events (death or myocardial infarction) occurred in 7 patients (9%). Episodes of ST-segment depression on Holter monitoring were found in 6 of 7 patients (86%) with and in 26 of 68 patients (38%) without events (p <0.05). There were no differences between patients with or without events in both time domain (standard deviation [SD] of all normal RR intervals in the entire 24-hour electrocardiographic recording (SDNN), SD of the mean RR intervals for all 5-minute segments (SDANN-i), mean of SD of all RR intervals for all 5-minute segments (SDNN-i), percentage of differences between adjacent RR intervals >50 ms (pNN50), and square root of the mean squared differences of successive RR intervals) (RMSSD), and frequency domain (ultra low, very low, low, and high frequency) HRV indexes. However, the low-frequency/high-frequency (LF/HF) ratio was significantly higher in patients with cardiac events (2.12 +/- 1.4 vs 1.48 +/- 0.5, p = 0.01). Moreover, when considering only the 32 patients with myocardial ischemic episodes on Holter monitoring, the LF/HF ratio was again higher in the 6 patients with than the 26 patients without major cardiac events (2.45 +/- 1.5 vs 1.31 +/- 0.3, p <0.01). Multivariate logistic regression, including clinical and angiographic variables, showed that transient ischemia on Holter monitoring was the only independent determinant of outcome (odds ratio = 12.2, p = 0.03), with the LF/HF ratio being only slightly over statistical significance (odds ratio for 0.1 increments = 2.8, p = 0.08). Our data confirm that transient ischemia on Holter monitoring is a powerful predictor of cardiac events in unstable angina and indicates that an imbalance in cardiac autonomic tone toward a prevalence of sympathetic activity increases the risk of events in this group of patients.

Hepatitis C virus infection of salivary gland epithelial cells. Lack of evidence

BACKGROUND

Hepatitis C virus genome (HCV-RNA) has been detected in whole salivary gland tissue of chronically infected patients. However, contamination of the tissue by plasma or blood cells was not excluded by the previous reports.

AIMS

To assess whether HCV infects the salivary gland epithelial cells in patients with chronic HCV liver disease.

METHODS

Twenty unselected patients with chronic active hepatitis (11 cases) or active cirrhosis (nine cases) were examined. Serum and saliva samples were obtained from all patients, 12 of whom (seven, chronic active hepatitis; five, active cirrhosis) underwent salivary gland biopsy. PCR for HCV-RNA was performed on RNA extracted from serum, saliva and salivary gland epithelial cells collected by isokinetic gradient separation after trypsin digestion of whole salivary gland tissue. Saliva samples were also examined for the presence of secretory IgA anti-HCV by gel chromatography and ELISA testing.

RESULTS

HCV-RNA was detected in all sera with titers ranging from 5.42 x 10(5) genome equivalents/ml to 123.2 x 10(5) genome equivalents/ml. Thirteen patients were infected with genotype 1b, four patients had genotype 1a, two patients had genotype 2a and one patient was unclassifiable. Low titer HCV-RNA (<2 x 10(5) genome equivalents/ml) was detected in 3/20 saliva samples (15%) from highly viremic patients infected with 1b genotype. RNA extracted from salivary gland epithelial cells consistently tested negative for HCV-RNA. In addition, all saliva specimens tested negative for secretory-IgA (S-IgA) anti-HCV, even after a 10-fold concentration of the samples.

CONCLUSIONS

There was no evidence that HCV infects the salivary gland epithelial cells in our viremic patients with HCV chronic liver disease. Low level HCV-RNA in saliva is most probably due to virus spillover from blood.