Single-tube four-target lateral flow assay detects human papillomavirus types associated with majority of cervical cancers

Isothermal nucleic acid amplification methods have many advantages for use at the point of care. However, there is a lack of multiplexed isothermal amplification tests to detect multiple targets in a single reaction, which would be valuable for many diseases, such as infection with high-risk human papillomavirus (hrHPV). In this study, we developed a multiplexed loop-mediated isothermal amplification (LAMP) reaction to detect the three most common hrHPV types that cause cervical cancer (HPV16, HPV18, and HPV45) and a cellular control for sample adequacy. First, we characterized the assay limit of detection (LOD) in a real-time reaction with fluorescence readout; after 30 min of amplification the LOD was 100, 10, and 10 copies/reaction of HPV16, HPV18, and HPV45, respectively, and 0.1 ng/reaction of human genomic DNA (gDNA). Next, we implemented the assay on lateral flow strips, and the LOD was maintained for HPV16 and HPV18, but increased to 100 copies/reaction for HPV45 and to 1 ng/reaction for gDNA. Lastly, we used the LAMP test to evaluate total nucleic acid extracted from 38 clinical samples; compared to qPCR, the LAMP test had 89% sensitivity and 95% specificity. When integrated with sample preparation, this multiplexed LAMP assay could be useful for point-of-care testing.

A novel tailed primer nucleic acid test for detection of HPV 16, 18 and 45 DNA at the point of care

Cervical cancer is a leading cause of death for women in low-resource settings despite being preventable through human papillomavirus (HPV) vaccination, early detection, and treatment of precancerous lesions. The World Health Organization recommends high-risk HPV (hrHPV) as the preferred cervical cancer screening strategy, which is difficult to implement in low-resource settings due to high costs, reliance on centralized laboratory infrastructure, and long sample-to-answer times. To help meet the need for rapid, low-cost, and decentralized cervical cancer screening, we developed tailed primer isothermal amplification and lateral flow detection assays for HPV16, HPV18, and HPV45 DNA. We translated these assays into a self-contained cartridge to achieve multiplexed detection of three hrHPV genotypes in a disposable cartridge. The developed test achieves clinically relevant limits of detection of 50-500 copies per reaction with extracted genomic DNA from HPV-positive cells. Finally, we performed sample-to-answer testing with direct lysates of HPV-negative and HPV-positive cell lines and demonstrated consistent detection of HPV16, HPV18, and HPV45 with 5000-50,000 cells/mL in < 35 min. With additional optimization to improve cartridge reliability, incorporation of additional hrHPV types, and validation with clinical samples, the assay could serve as a point-of-care HPV DNA test that improves access to cervical cancer screening in low-resource settings.

An integrated isothermal nucleic acid amplification test to detect HPV16 and HPV18 DNA in resource-limited settings

High-risk human papillomavirus (HPV) DNA testing is widely acknowledged as the most sensitive cervical cancer screening method but has limited availability in resource-limited settings, where the burden of cervical cancer is highest. Recently, HPV DNA tests have been developed for use in resource-limited settings, but they remain too costly for widespread use and require instruments that are often limited to centralized laboratories. To help meet the global need for low-cost cervical cancer screening, we developed a prototype, sample-to-answer, point-of-care test for HPV16 and HPV18 DNA. Our test relies on isothermal DNA amplification and lateral flow detection, two technologies that reduce the need for complex instrumentation. We integrated all test components into a low-cost, manufacturable platform, and performance of the integrated test was evaluated with synthetic samples, provider-collected clinical samples in a high-resource setting in the United States, and self-collected clinical samples in a low-resource setting in Mozambique. We demonstrated a clinically relevant limit of detection of 1000 HPV16 or HPV18 DNA copies per test. The test requires six user steps, yields results in 45 min, and can be performed using a benchtop instrument and minicentrifuge by minimally trained personnel. The projected per-test cost is <$5, and the projected instrumentation cost is <$1000. These results show the feasibility of a sample-to-answer, point-of-care HPV DNA test. With the inclusion of other HPV types, this test has the potential to fill a critical gap for decentralized and globally accessible cervical cancer screening.

Engineered Bacteria for Short-Chain-Fatty-Acid-Repressed Expression of Biotherapeutic Molecules

Short-chain fatty acids (SCFA) such as propionate and butyrate are critical metabolites produced by the gut microbiota. Microbiome dysbiosis resulting in altered SCFA profiles is associated with certain diseases, including inflammatory bowel diseases (IBD), characterized by a reduction in butyrate concentration and active intestinal inflammation. There is an increasing interest in the use of engineered bacteria as diagnostic and therapeutic tools for gut diseases. In this study, we developed genetic circuits capable of sensing SCFA concentrations to build biosensors that express a response protein (superfolder green fluorescent protein [sfGFP]) in amounts inversely proportional to the SCFA concentration. We also built biotherapeutics expressing the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) using the same logic. The propionate biotherapeutic expressed larger amounts of mouse GM-CSF in the absence of propionate. The butyrate biotherapeutics presented the expected behavior only at the beginning of the kinetics and an accelerated response in the absence of butyrate. Overall, these genetic systems may function as complementary diagnostic tools for measuring SCFAs and as delivery vehicles for biotherapeutic molecules. IMPORTANCE Short-chain fatty acids are key molecules produced by the gut microbiome. Their concentrations are altered in certain diseases. Here, we created molecular biosensors that quantify the absence of propionate and butyrate, using logic "NOT" gates and bacterial promoters. Finally, we show that these genetic systems could be useful for the delivery of therapeutic molecules in the gut, in the absence of these acids.

Developing a Fluorescent Inducible System for Free Fucose Quantification in Escherichia coli

L-Fucose is a monosaccharide abundant in mammalian glycoconjugates. In humans, fucose can be found in human milk oligosaccharides (HMOs), mucins, and glycoproteins in the intestinal epithelium. The bacterial consumption of fucose and fucosylated HMOs is critical in the gut microbiome assembly of infants, dominated by Bifidobacterium. Fucose metabolism is important for the production of short-chain fatty acids and is involved in cross-feeding microbial interactions. Methods for assessing fucose concentrations in complex media are lacking. Here we designed and developed a molecular quantification method of free fucose using fluorescent Escherichia coli. For this, low- and high-copy plasmids were evaluated with and without the transcription factor fucR and its respective fucose-inducible promoter controlling the reporter gene sfGFP. E. coli BL21 transformed with a high copy plasmid containing pFuc and fucR displayed a high resolution across increasing fucose concentrations and high fluorescence/OD values after 18 h. The molecular circuit was specific against other monosaccharides and showed a linear response in the 0-45 mM range. Adjusting data to the Hill equation suggested non-cooperative, simple regulation of FucR to its promoter. Finally, the biosensor was tested on different concentrations of free fucose and the supernatant of Bifidobacterium bifidum JCM 1254 supplemented with 2-fucosyl lactose, indicating the applicability of the method in detecting free fucose. In conclusion, a bacterial biosensor of fucose was validated with good sensitivity and precision. A biological method for quantifying fucose could be useful for nutraceutical and microbiological applications, as well as molecular diagnostics.

Covid-19 vaccination adherence and correlated factors in patients with substance use disorders

Background

Analyzing trends and patterns of vaccination during COVID-19 pandemic is important to understand how current policies are working. Evidence regarding the general population is already available, but hard-to-reach populations as migrants or minorities, but also people suffering from a Substance Use Disorder (SUD), have not been fully explored. To understand the extent of vaccine adherence and evaluate associated factors in this population subgroup, we conducted a cross-sectional study in collaboration with Villa Marini Foundation, national agency of the Italian Red Cross for pathological addictions.

Methods

We developed a questionnaire regarding COVID-19 vaccination, adherence to prevention measures, concerns about COVID-19 and questions relating to drug use that we administered to each participant. Only people aged over 18 with a diagnosis of SUD were included in the study. A multivariable logistic regression model was built to identify the predictors associated with anti-SARS-CoV-2 vaccination, estimating adjusted odds ratios (aOR) and 95% confidence intervals (CIs).

Results

We recruited 200 participants between December 2021 and January 2022. Most respondents were male (84.5%), Italian (72%), aged 44 years on average. A total of 40 patients (20%) reported they haven't received any dose of COVID-19 vaccine; the most common motivations were lack of trust in the vaccine and fear of side effects. At multivariable analysis, the use of heroin appears to be negatively associated with vaccination acceptance (aOR=0.31 CI 95%: 0.11-0.81) as well as not being Italian (aOR=0.27 CI 95%: 0.12-0.63).

Conclusions

The vaccination rate in our sample was consistent with the one of the general Italian population in the same period, whereas the reasons behind the lower adherence to vaccination in the heroin group need to be further investigated. It’s also important to reduce possible bureaucratic obstacles that could explain the lower number of vaccinated foreign citizens.

Key messages

• People with Substance Use Disorder are a fragile and often overlooked population that needs to be considered during Public Health intervention and vaccination campaigns.

• The access to vaccination for foreigners should be made more simple and easier to increase accessibility and participation.

Engineered Probiotics for Detection and Treatment of Inflammatory Intestinal Diseases

Inflammatory intestinal diseases such as Crohn's disease and ulcerative colitis have seen an increase in their prevalence in developing countries throughout the current decade. These are caused by a combination of genetic and environmental factors, altered immune response, intestinal epithelium disruption and dysbiosis in the gut microbiome. Current therapies are mainly focused on treating symptoms and are often expensive and ineffective in the long term. Recently, there has been an increase in our understanding of the relevance of the gut microbiome and its impact on human health. Advances in the use of probiotics and synthetic biology have led to the development of intestinal biosensors, bacteria engineered to detect inflammation biomarkers, that work as diagnostic tools. Additionally, live biotherapeutics have been engineered as delivery vehicles to produce treatment in situ avoiding common complications and side effects of current therapies. These genetic constructs often express a therapeutic substance constitutively, but others could be regulated externally by specific substrates, making the production of their treatment more efficient. Additionally, certain probiotics detecting specific biomarkers in situ and responding by generating a therapeutic substance are beginning to be developed. While most studies are still in the laboratory stage, a few modified probiotics have been tested in humans. These advances indicate that live biotherapeutics could have great potential as new treatments for inflammatory intestinal diseases.

Effects of Osmotic Therapy on Pupil Reactivity: Quantification Using Pupillometry in Critically Ill Neurologic Patients

BACKGROUND

Osmotic therapy is a critical component of medical management for cerebral edema. While up to 90% of neurointensivists report using these treatments, few quantitative clinical measurements guide optimal timing, dose, or administration frequency. Its use is frequently triggered by a qualitative assessment of neurologic deterioration and/or pupil size, and anecdotally appears to improve pupil asymmetry suggestive of uncal herniation. However, subjective pupil assessment has poor reliability, making it difficult to detect or track subtle changes. We hypothesized that osmotic therapy reproducibly improves quantitative pupil metrics.

METHODS

We included patients at two centers who had recorded quantitative pupil measurements within 2 h before and after either 20% mannitol or 23.4% hypertonic saline in the neurosciences intensive care unit. The primary outcome was the Neurologic Pupil Index (NPi), a composite metric ranging from 0 to 5 in which > 3 is considered normal. Secondary outcomes included pupil size, percent change, constriction and dilation velocity, and latency. Results were analyzed with Wilcoxon signed-rank tests, Chi-square and multi-level linear regression to control for other edema-reducing interventions.

RESULTS

Out of 72 admissions (403 paired pupil observations), NPi significantly differed within 2 h of osmotic therapy when controlling for other commonly used interventions in our whole cohort (β = 0.08, p = 0.0168). The effect was most pronounced (β = 0.57) in patients with abnormal NPi prior to intervention (p = 0.0235).

CONCLUSIONS

Pupil reactivity significantly improves after osmotic therapy in a heterogenous critically ill population when controlling for various other interventions. Future work is necessary to determine dose-dependent effects and clinical utility.

The Marine Fungi Rhodotorula sp. (Strain CNYC4007) as a Potential Feed Source for Fish Larvae Nutrition

Fish oil is used in the production of feed for cultured fish owing to its high polyunsaturated fatty acid content (PUFA). The over-exploitation of fisheries and events like “El Niño” are reducing the fish oil supply. Some marine microorganisms are considered potentially as alternative fatty acid sources. This study assesses a strain of Rhodotorula sp. (strain CNYC4007; 27% docosahexaenoic acid (DHA) of total fatty acids), as feed for fish larvae. The total length and ribonucleic acid (RNA)/deoxyribonucleic acid (DNA) ratio of Danio rerio larvae was determined at first feeding at six and 12 days old (post-yolk absorption larvae). Larvae fed with microencapsulated Rhodotorula sp. CNYC4007 had a significantly higher RNA/DNA ratio than control group (C1). At six days post-yolk absorption group, the RNA/DNA ratio of larvae fed with Rhodotorula sp. bioencapsulated in Brachionus sp. was significantly higher than control group fed with a commercial diet high in DHA (C2-DHA). Finally, at 12 days post-yolk absorption, the RNA/DNA ratio was significantly higher in larvae fed with Rhodotorula sp. CNYC4007 and C2-DHA (both bioencapsulated in Artemia sp. nauplii) than in control group (C1). These results suggest that Rhodotorula sp. CNYC4007 can be an alternative source of DHA for feeding fish at larval stage, providing a sustainable source of fatty acids.

Spatial variations in feeding habits and trophic levels of two small pelagic fish species in the central Mediterranean Sea

Trophic ecology of adults of European sardine (Sardina pilchardus) and anchovy (Engraulis encrasicolus) was examined and compared among various regions of central Mediterranean Sea. Carbon and nitrogen stable isotope analyses (δ(13)C and δ(15)N) were adopted as a tool to determine changes in feeding behaviour of adults of sardines and anchovies. In the study period (summer) a clear geographical pattern was recognized in the isotopic composition of both species, with an increasing trend northward. The highest variations in isotopic signal were linked to the geographical positions of the samples and, especially, between pairs of areas: South Sicily/South Campania and Gulf of Gaeta/South Elba. Higher isotope values were found in the anchovies and sardines caught in northern Tyrrhenian Sea, while lower values were mostly estimated in the southern region. Higher carbon and nitrogen isotopes may reflect a more coastal behaviour of both species, being (13)C-enriched source from benthic primary producers in addition to phytoplankton. Variations in the nitrogen isotope ratio may reflect not only differences in the trophic level of prey species, but also variations in the baseline level of food webs. Our results support the hypothesis that feeding behaviour of both species is directly or indirectly influenced by local factors, or by resource partitioning based on zooplankton size. Findings can supply knowledge needed for improving fish stock management and promoting plans able to take into account also local ecosystem analysis.

Systematic review with meta-analysis: the risk of major gastrointestinal bleeding with non-vitamin K antagonist oral anticoagulants

BACKGROUND

Gastrointestinal (GI) bleeding is a common complication among anticoagulated patients. Non-vitamin K antagonist oral anticoagulants (NOACs) are associated with increased risk of GI (major and clinically relevant non-major) bleeding. However, more information is needed regarding severe events.

AIM

To evaluate the risk of NOACs major GI bleeding.

METHODS

We searched for phase III randomised clinical trials (RCT) evaluating NOACs (apixaban, dabigatran, edoxaban and rivaroxaban) and reporting major GI bleeding events, in MEDLINE, Cochrane Library, SciELO collection and Web of Science databases (July 2015). Meta-analysis was performed to estimate risk ratio (RR) and 95% confidence intervals (95% CIs). Heterogeneity was assessed with the I(2) test.

RESULTS

A total of 23 studies were included. Among patients with atrial fibrillation, the risk of major GI bleeding was not different between NOACs and vitamin K antagonists (VKA) (RR 1.08, 95% CI 0.85-1.36, I(2)  = 78%; 5 RCTs) or acetylsalicylic acid (RR 0.78, 95% CI 0.36-1.72; 1 RCT). Similar results were found for patients undergoing orthopaedic surgery and those with venous thromboembolism. NOACs were not found to increase the risk compared to low-molecular-weight heparin (LWMH) alone (RR 1.42, 95% CI 0.55-3.71, I(2)  = 7%; 8 RCTs), the sequential treatment with LMWH-VKA (RR 0.77, 95% CI 0.49-1.21, I(2)  = 43%; 7 RCTs) or placebo (RR 1.48, 95% CI 0.15-14.84, I(2)  = 21%; 2 RCTs).

CONCLUSION

Despite previous evidence supporting the association of non-vitamin K antagonist oral anticoagulants and overall GI bleeding, non-vitamin K antagonist oral anticoagulants are not associated with increased risk of major GI bleeding compared to other anticoagulant drugs (with known increased risk of these events).

Metals content in otoliths of Dicentrarchus labrax from two fish farms of Sicily

Otoliths of cultured sea bass (Dicentrarchus labrax) from two different fish farms of Sicily were collected and analyzed by using inductively coupled plasma optical emission spectroscopy. Metal content (Ba, Cd, Fe, Mg, Mn, Sr, and Zn) was measured in order to test the potential use of biogenic carbonates as proxies of dissimilar environmental conditions since the fish farms are implanted in opposite coastal marine areas (Gulf of Castellammare and Gulf of Gela) characterized by different oceanographic features and human activities. Cluster analysis discriminates samples as different groups on the basis of metal content. Results show that concentrations of Sr in the otoliths have a similar range of distribution and not significantly different between the two farms. Otherwise, Fe, Mg, Mn, and Cd show higher concentrations in otoliths collected from fish reared in the farm in the southern coast (Gulf of Gela), an area subject to a great anthropogenic pressure. Zn is the only element with higher values in the otoliths from the farm in the northern coast (Gulf of Trappeto) probably due to industrial effluent. In this work, obtained data confirm the high potential of trace elements measurements in these biogenic carbonates as proxies of different environmental conditions.

Real-time monitoring of self-assembling worm-like micelle formation by organic transistors

OECT (Fig. a) for monitoring micelle formation in a spherical (red points – Fig. b) and a wormlike (blue points – Fig. b) regime solutions.

The sea-air exchange of mercury (Hg) in the marine boundary layer of the Augusta basin (southern Italy): concentrations and evasion flux

The first attempt to systematically investigate the atmospheric mercury (Hg) in the MBL of the Augusta basin (SE Sicily, Italy) has been undertaken. In the past the basin was the receptor for Hg from an intense industrial activity which contaminated the bottom sediments of the Bay, making this area a potential source of pollution for the surrounding Mediterranean. Three oceanographic cruises have been thus performed in the basin during the winter and summer 2011/2012, where we estimated averaged Hgatm concentrations of about 1.5±0.4 (range 0.9-3.1) and 2.1±0.98 (range 1.1-3.1) ng m(-3) for the two seasons, respectively. These data are somewhat higher than the background Hg atm value measured over the land (range 1.1±0.3 ng m(-3)) at downtown Augusta, while are similar to those detected in other polluted regions elsewhere. Hg evasion fluxes estimated at the sea/air interface over the Bay range from 3.6±0.3 (unpolluted site) to 72±0.1 (polluted site of the basin) ng m(-2) h(-1). By extending these measurements to the entire area of the Augusta basin (~23.5 km(2)), we calculated a total sea-air Hg evasion flux of about 9.7±0.1 g d(-1) (~0.004 tyr(-1)), accounting for ~0.0002% of the global Hg oceanic evasion (2000 tyr(-1)). The new proposed data set offers a unique and original study on the potential outflow of Hg from the sea-air interface at the basin, and it represents an important step for a better comprehension of the processes occurring in the marine biogeochemical cycle of this element.

Towards the realization of label-free biosensors through impedance spectroscopy integrated with IDES technology

Impedance spectroscopy (IS) is a powerful technique for analysis of the complex electrical impedance of a large variety of biological systems, because it is sensitive both to surface phenomena and to changes of bulk properties. A simple and convenient method of analysis of cell properties by IS is described. An interdigitated electrodes configuration was used for the measurements; human epithelial cells were grown on the device to investigate the complex dielectric response as a function of frequency, in order to test the suitability of the device for use as a label-free biosensor. To test the ability of the device to detect channels in the cell membrane, the effect of drugs known to affect membrane integrity was also investigated. The frequency response of the admittance (i.e. the reciprocal of the impedance) can be well fitted by a model based on very simple assumptions about the cells coating the device surface and the current flow; from the calculations, membrane-specific capacitance and information about cell adhesion can be inferred. These preliminary efforts have shown that our configuration could lead to a label-free non-invasive technique for biosensing and cellular behavior monitoring which might prove useful in investigation of the basic properties of cells and the effect of drugs by estimation of some fundamental properties and modification of the electrical characteristics of the device.

Environmental, physical and structural characterisation of geopolymer matrixes synthesised from coal (co-)combustion fly ashes

The synthesis of geopolymer matrixes from coal (co-)combustion fly ashes as the sole source of silica and alumina has been studied in order to assess both their capacity to immobilise the potentially toxic elements contained in these coal (co-)combustion by-products and their suitability to be used as cement replacements. The geopolymerisation process has been performed using (5, 8 and 12 M) NaOH solutions as activation media and different curing time (6-48 h) and temperature (40-80 degrees C) conditions. Synthesised geopolymers have been characterised with regard to their leaching behaviour, following the DIN 38414-S4 [DIN 38414-S4, Determination of leachability by water (S4), group S: sludge and sediments. German standard methods for the examination of water, waste water and sludge. Institut für Normung, Berlin, 1984] and NEN 7375 [NEN 7375, Leaching characteristics of moulded or monolithic building and waste materials. Determination of leaching of inorganic components with the diffusion test. Netherlands Normalisation Institute, Delft, 2004] procedures, and to their structural stability by means of compressive strength measurements. In addition, geopolymer mineralogy, morphology and structure have been studied by X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR), respectively. It was found that synthesised geopolymer matrixes were only effective in the chemical immobilisation of a number of elements of environmental concern contained in fly ashes, reducing (especially for Ba), or maintaining their leachable contents after the geopolymerisation process, but not for those elements present as oxyanions. Physical entrapment does not seem either to contribute in an important way, in general, to the immobilisation of oxyanions. The structural stability of synthesised geopolymers was mainly dependent on the glass content of fly ashes, attaining at the optimal activation conditions (12 M NaOH, 48 h, 80 degrees C) compressive strength values about 60 MPa when the fly ash glass content was higher than 90%.

[The pacifism of Henry Dunant]

From various writings of the founder of the International Red Cross and above all from his late work L'avenir sanglant it is deduced as the Dunant anticipating and prophetically interpreting the curse of the war is an internationalist (for some aspects a romantic anarchist) and a convinced pacifist. We show therefore how much has been false and backbiters the defamations that followed to the attribution of the first Nobel prize for the peace.

Photosynthetic O2 formation tracked by time-resolved x-ray experiments

Plants and cyanobacteria produce atmospheric dioxygen from water, powered by sunlight and catalyzed by a manganese complex in photosystem II. A classic S-cycle model for oxygen evolution involves five states, but only four have been identified. The missing S4 state is particularly important because it is directly involved in dioxygen formation. Now progress comes from an x-ray technique that can monitor redox and structural changes in metal centers in real time with 10-microsecond resolution. We show that in the O2-formation step, an intermediate is formed--the enigmatic S4 state. Its creation is identified with a deprotonation process rather than the expected electron-transfer mechanism. Subsequent electron transfer would give an additional S4' state, thus extending the fundamental S-state cycle of dioxygen formation.

[Applicability of the new law of State and Regional Agreement on management of swimming pools]

The Authors carried out a survey on private and public managers of 80 Italian swimming pools to evaluate the hygienic aspects and safety of the swimming pools. Participants were submitted to a set of questions about the modifications recently brought to the Act on management of the swimming pools during 2003. The study showed a poor knowledge about the hygienic-safety parameters, in particular of chlorine doses, range of temperature and frequency of daily turnover of the swimming pool water. The respect of chemical-physical parameters is necessary not only to assure an adequate microbial control of the water, but also to reduce the production of irritant and potentially toxic substances. The Authors pointed out the need of greater attention to hygienic aspects in order to reduce health risks, deriving from an uncorrected application of the laws, and to provide a greater comfort to the users of swimming pools.

Fetal myocardial hypertrophy in an experimental model of gestational diabetes

INTRODUCTION

The frequent occurrence of prenatal hypertrophy of the muscular ventricular septum has been widely reported in fetuses of diabetic mothers.

OBJECTIVES

This experimental study was carried out to test the hypothesis that the weight of the heart, the ratio of the cardiac weight to that of the body, the thickness of the muscular ventricular septum, and the myocytic profile within the ventricular septum are all increased in fetuses of diabetic rats in comparison to fetuses of normal rats.

METHODS

Diabetes was induced in 5 pregnant Wistar rats, bearing 30 fetuses, on the eighth day after conception, by intraperitoneal injection of 50 mg/kg of streptozotocin. Five normal pregnant Wistar rats, bearing 20 fetuses, made up the control group. Morphometric data were obtained by a computer-assisted method applied to the measurements of the thickness of the ventricular septum, and myocytic nuclear area. Statistical analysis utilized Student's t-test and Kruskal-Wallis test.

RESULTS

The mean thickness of the septum was 675.56 microm (+/-159) in the control fetuses, and 904.39 microm (+/-262) in the fetuses carried by diabetic mothers (p < 0.001). The cardiac weight was 0.016 g (+/-0.004) in the control group, and 0.023 g (+/-0.005) in the group of diabetic fetuses (p < 0.001). The ratio of cardiac to body weight was 0.294% (+/-0.079) in the control group, and 0.514% (+/-0.073) in the diabetic group (p < 0.001). The myocytic nuclear area was 14.70 microm2 in the control group, and 21.43 microm2 in the diabetic group (p < 0.001).

CONCLUSIONS

The presence of cellular and morphologic cardiac hypertrophy in fetuses of diabetic rats was demonstrated by the significant difference between the two groups for each analyzed feature.

[Stomach rupture due to barotrauma (a report of the 13th case since 1969)]

The thirteenth case of rupture of the stomach after a diving accident since 1969 is reported. This rare event was caused by equipment failure and panic reaction, which induced swallowing air during diving and consequential gas expansion in gastric cavity meanwhile the rapid ascent. Peritoneal decompression by paracentesis quickly improved the patient's condition and the following surgical laparotomy revealed a gastric tear along the lesser curvature, which was closed by suturing. The patient presented a postoperative splenic abscess two months later; literature demonstrated that rupture of a filled stomach may lead to septic complications.

[Emergency surgery in inflammatory bowel disease. Experience in 26 cases]

BACKGROUND

The emergency surgical treatment of inflammatory chronic bowel diseases is closely related to the classification of patients according to their symptoms and clinical conditions, as well as possible surgical options. In our study, an actual set of criteria is proposed for the classification of the degree of seriousness of symptoms, related to patient conditions, and applicable surgical strategies.

METHODS

Retrospectively evaluation of the outcome of the disease has been performed over 26 patients undergoing emergency treatment in our Hospital, and with at least 5 years of follow-up. Fourteen patients were affected by ulcerative rectocolitis and 11 underwent subtotal colectomy with ileostomy; the remaining 12 were affected by Crohn's disease and were treated with colic or ileal local resection.

RESULTS

Among 11 operated patients with RCU, 6 toxic megacolon, 4 severe colitis and one perforation (postoperative death) have been diagnosed. Recanalization was possible in 8 patients. On the other hand proctectomy was necessary in the remaining 3 patients as final operation. In MC patients 6 occlusions, 4 severe colitis, one multiple perineal fistulization and one perforation of occult right colon tumor have been diagnosed. We performed 5 right colectomy, 4 jejuno-ileal resections, one Hartmann's operation, one colostomy in emergency and one multiple bypass. Because of recurrence, one right colectomy needed following total colectomy and two jejuno-ileal resections needed right colectomy soon after. Three jejuno-ileal resections were performed with a conservative purpose in patients treated by right colectomy.

CONCLUSIONS

It has resulted that in ulcerative rectocolitis total colectomy actually permits an adequate control of the disease, as well as a satisfactory therapy of the rectal stump, with subsequent recanalization in the majority of cases, whereas in Crohn's disease the frequency of recidive is higher and it seems more advisable to opt for a radical resection treatment (chiefly right colectomy), but with a conservative purpose.

[Balanced beta--alpha-blocker treatment with carvedilol in mild-moderate arterial hypertension]

The search for the ideal antihypertensive drug is ongoing. Carvedilol is a new beta-adrenoceptor antagonist which also causes peripheral vasodilation primarily via alpha 1-adrenergic blockade. Twenty patients with mild to moderate essential hypertension and previous intolerance and side effects to other antihypertensive drugs were studied. After initial baseline assessment, patients received 25 mg carvedilol orally q.d. The treatment lasted 60 days. In our study carvedilol was well tolerated and no important side effect was recorded. Blood pressure decreased significantly to normal values, without orthostatic blood pressure decreases. Heart rate decreased significantly too, but no significant bradycardia was induced. No negative effects on serum lipids and no clinical evidence of increase in peripheral resistance were observed. Ventricular arrhythmia on Holter monitoring were significantly reduced after treatment with carvedilol.

[Our experience with the surgical treatment of carcinoma of the colon]

The Authors analyze a series of 441 patients affected by carcinoma of the colon operated on between June 1980 and November 1993. The incidence of the different stages of the disease according to Dukes resulted comparable to that reported in the literature as well as the incidence of morbidity and mortality. Recostruction was performed in all cases with mechanical sutures (T-L for the right colon and L-T for the left colon) and without protection enterostomy. Long-term results evaluated by actuarial methods were influenced by the stage of the disease, and not by sex or duration of symptoms. The need of early diagnosis as well as oncologically correct surgical technique is furthermore confirmed. The importance of clinical trials on adjuvant chemotherapy is emphasized in order to improve survival in patients operated for stage B and C colon cancer.

[The therapy of the liver metastases of colorectal carcinoma]

The treatment of liver metastases should be addressed in a multidisciplinary way, considering the manifold therapeutic options available, for each of which corresponds a particular indication. The best results are obtainable with resective surgery in cases in which there is a partial involvement of the liver (25-50%) and a variable intra-hepatic distribution (monolobar), situations that correspond to Gennari stages I and II. In the authors' experience, the extent of the liver resection does not influence possible survival and oncologically correct resections should be carried out such as segmentectomies, pluri-segmentectomies or wedge resection in compliance with the principle of removing at least 1.5 cm of healthy perineoplastic tissue. The authors reserve major hepatectomies to special situations: voluminous metastases, diffuse involvement of a single lobe, topographic localisation contraindicating segmentary resection.

[Primary malignant tumors of the small intestine: the diagnostic and therapeutic considerations]

The authors report their experience in the management of five patients affected by small bowel neoplasms (2 adenocarcinomas, 1 carcinoid tumor, 1 leiomyosarcoma and 1 non-Hodgkin's lymphoma) operated from June '92 to September '93. Diagnostic and therapeutical aspects of this uncommon pathology are discussed.

[The surgical treatment of malignant neoplasms of the pancreas: resection or palliative intervention?]

The authors retrospectively evaluate their 10-year experience in the surgical management of pancreatic cancer, and analyze their results in terms of morbidity and long-term survival. The comparison between curative and palliative surgery shows, in this series, a better long-term survival and a better performance status for the patients in the curative group, although postoperative morbidity and mortality are higher. The difficulty of an early diagnosis as well as a correct preoperative staging is confirmed. Finally, the authors propose a personal, totally mechanic technique of digestive tract restoration after gastric resection during pancreatic surgery underlining this procedure is easy, safe, fast and functional.

[Theoretical and practical aspects of globular sedimentation velocity]

The following methods used to determine globular sedimentation rate (VSG) were reviewed: Westergren and Wintrobe techniques, Chattas micromethod, Sibora and Sediplast systems and z percentage sedimentation. Also included are the VSG phases and those factors which determine the aggregation of the red corpuscles whether they be plasmatic, globular or extrinsic.

[Modified erythrocyte sedimentation rate. Study in pre-school and school children]

The Westergren inclined technique can be used to determine the globular sedimentation rate (GSR) at 10 and 15 minutes which are equivalent to the first and second hours respectively of the classic method. The present study compares GSR correlations using both methods, on a sample of 64 healthy children, included according to predetermined study selection criteria. The sample included 38 preschoolers (59.37%) and 26 school children (48.63%); with an age range between 4.14 +/- 0.48 years and 8.68 +/- 0.62 years (mean +/- 2 EE) respectively. The hematocrit range was between 38.75 +/- 0.56 Vol%; no erythrocyte alterations were observed. A significant positive correlation was observed in the GSR determinations between 1 hour-10 min and 2 hours-15 min, which were r1 = 0.9049 (P less than 0.001) and r2 = 0.9404 (P less than 0.001). No significant difference (P greater than 0.05) was noted on the basis of sex (34 males, 30 females). The determinations taken with the Westergren inclined method proved superior to the classic method, but the technique requires the inclusion of normal values of the former. The conclusion is that the inclined method can be used and interpreted by the clinician in the same way as the classic Westergren method. It permits a time saving, which in large hospital practices implies an important economic factor.

Ventricular and dual chamber pacing for treatment of carotid sinus syndrome

Thirty-nine consecutive patients with recurrent syncope and either cardioinhibitory or mixed type carotid sinus syndrome were studied to determine the efficacy of ventricular (VVI) pacing in 16, and dual chamber (DDD/DVI) in 23 patients. Only those patients affected by the isolated vasodepressor form were excluded. Follow-up lasted 12 +/- 5 months. Symptoms were totally eliminated in 67% of patients and ameliorated with persistence of minor symptoms in 33%. All patients underwent an initial 2-month follow-up in the VVI mode. Evaluation of the 19 patients who remained symptomatic and the 20 who became asymptomatic with VVI pacing demonstrated that factors observed prior to pacemaker implant were related to failure of the VVI mode. These included symptomatic pacemaker effect (42% vs 0%), mixed carotid sinus syndrome (95% vs 65%), orthostatic hypotension (47% vs 15%), or ventriculoatrial conduction (68% vs 38%). In the 23 patients with dual chamber pacing, random 2 month comparisons were performed between VVI and DVI/DDD pacing. The dual chamber mode was preferred by 14 patients, none preferred the VVI mode and nine noted no difference. Comparison of the two groups found that the factors linked to DVI/DDD preference were symptomatic pacemaker effect (50% vs 0%), ventriculoatrial conduction (78% vs 44%), or orthostatic hypotension (50% vs 11%). VVI pacing is efficacious in a high proportion of patients affected by cardioinhibitory or mixed carotid sinus syndrome. The identification of causes of VVI pacing failure allows determination of those who will benefit from VVI pacing and those who should have DVI/DDD. VVI pacing is suggested for the cardioinhibitory type with no symptomatic pacemaker effect and for the mixed type with no symptomatic pacemaker effect or orthostatic hypotension or ventriculoatrial conduction. Dual chamber pacing should be used in all other instances.

Natural and unnatural history of patients with severe carotid sinus hypersensitivity: a preliminary study

Natural history of patients with symptomatic severe carotid sinus hypersensitivity is not clearly known. In order to evaluate the effectiveness of pacing therapy in these patients we performed a randomized treatment/no-treatment prospective study in 35 patients. They were randomly assigned to two groups: 19 patients received no therapy, 16 patients received a VVI (#11) or DDD (#5) pacemaker implant. During the 8.4 +/- 4.3 month follow-up period patients receiving no therapy had recurrence of syncope in 9 cases (47%) and minor symptoms in 13 (68%); at the 16th month, actuarial curve showed absence of syncope in 36% of patients and of any symptoms in 30%. During the 7.2 +/- 4.1 month follow-up period, the patients receiving the pacemaker implant had no recurrence of syncope, minor symptoms in three (19%); at the 16th month, actuarial curve showed absence of syncope in 100% of patients and of any symptoms in 78%. During follow-up, 12 patients in no-treatment group received a pacemaker implant because of the recurrence of severe symptoms; successively they had a strong reduction of symptoms. In conclusion, this study definitively demonstrates that patients with severe symptomatic carotid sinus hypersensitivity had a high rate of recurrence of spontaneous symptoms and that in these patients cardiac pacing is a useful therapy.

Is DDD superior to VVI pacing in mixed carotid sinus syndrome? An acute and medium-term study

The aim of this study was to evaluate the importance of atrial synchronism for pacing therapy of patients with mixed carotid sinus syndrome. In 23 patients (21 m, two f; mean age 69 +/- 8 years) affected by symptomatic mixed carotid sinus syndrome we performed: (1) Research of ventriculo-atrial conduction, orthostatic hypotension and pacemaker effect; and (2) Carotid sinus massage in the standing position during VVI and DVI temporary pacing. Next, all patients received a permanent DDD pacemaker and entered a 2 month two period single-blind, randomized, cross-over study on DVI/DDD versus VVI mode. During the DVI/DDD period, no syncope occurred in any patients, minor symptoms persisted in 11 (48%) of them; during VVI period syncopes recurred in three patients, symptoms requiring the withdrawal of VVI pacing and premature DVI/DDD reprogramming in eight patients, minor symptoms in 17 (74%). A comparison between 14 patients, who preferred DVI/DDD period (Group A), and the remaining nine patients who noted no preference between DVI/DDD and VVI period (Group B) was performed on the basis of the preimplant evaluation. Group A patients had a greater pacemaker effect (-34 +/- 16 mmHg vs -16 +/- 14 mmHg) and a higher prevalence of symptomatic pacemaker effect (50% vs 0%), of ventriculo-atrial conduction (78% vs 44%) and of orthostatic hypotension (50% vs 11%), while the entity of the systolic pressure fall caused by carotid sinus massage was similar in the two groups either during VVI mode (Group A -51 +/- 16 mmHg vs Group B -56 +/- 27 mmHg) or DVI mode (Group A -38 +/- 17 mmHg vs Group B -45 +/- 17 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of permanent cardiac pacing and cardiac pacing on demand in mixed carotid sinus syndrome. Acute- and medium-term follow-up study]

The aim of the study was to evaluate the importance of atrial synchronism for pacing therapy of patients with mixed carotid sinus syndrome. On 23 patients (21 m, 2 f; mean age 69 +/- 8 years) affected by symptomatic mixed carotid sinus syndrome we performed: 1) the study of ventriculo-atrial conduction, 2) the evaluation of pacemaker effect and 3) the carotid sinus massage in standing position during VVI and DVI temporary pacing. All patients received a permanent DVI pacemaker and then underwent a two-month period single-blind, randomized, cross-over study on DVI vs VVI mode. During DVI period, no syncope occurred in any patients, minor symptoms persisted in 11 (48%) of them; during VVI period syncopes recurred in 3 patients, symptoms requiring the withdrawal of VVI pacing and premature DVI reprogramming in 8, minor symptoms were observed in 17 (74%). A comparison between 14 patients who preferred DVI period (Group A) and the remaining 9 patients who had no preference for DVI and VVI period (Group B) revealed that Group A patients had a greater pacemaker effect (-34 +/- 16 mmHg vs -16 +/- 14 mmHg; p less than 0.02) and a higher prevalence of ventriculo-atrial conduction (78% vs 44%; p = 0.1), while the entity of the systolic pressure fall caused by carotid sinus massage was similar in the two groups both during VVI mode (Group A -51 +/- 16 mmHg vs Group B -56 +/- 27 mmHg) and DVI mode (Group A -38 +/- 17 mmHg vs Group B -45 +/- 17 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in sinus function at rest and during physical exertion after permanent atrial electrostimulation in patients with sick sinus syndrome]

We studied the unnatural history of sinus node function in severe sick sinus syndrome treated with AAI or DDD pacemakers. In 19 patients (10 m; 9 f; mean age +/- 1 SD 69 +/- 7 years) we executed serial bicycle exercise tests and electrophysiological studies before, 7 days and 3 months after pacemaker implant. Sinus heart rate at maximum effort was: 118 +/- 23 beats/min and 117 +/- 23 beats/min (two different evaluations) before pacemaker implant, 125 +/- 21 beats/min after 7 days (p less than 0.05) and 133 +/- 20 beats/min after 3 months (p less than 0.001) with an average increment of 12.7%. A positive correlation (y = 50.4 + 0.7 X beats/min; p less than 0.001) between the first basal test and the third month one was found. In analogy exercise test lasted 8.7 +/- 3, 8.6 +/- 2.8, 9.5 +/- 2.5, 9.7 +/- 2.5 minutes respectively, with an average increment of 11.5% between the first basal test and the third month one. Sinus heart rate at maximum effort in 14 age matched normal subjects was 138 +/- 15 beats/min. The difference with sick sinus syndrome patients was statistical (p less than 0.05) when compared with the basal test but not with 3rd month test. Parameters determined during electrophysiological studies were: spontaneous heart rate, corrected sinus node recovery time, sino-atrial conduction time evaluated before and after autonomic blockade (propranolol 0.2 mg/kg i.v. plus atropine 0.04 mg/kg i.v.). All these parameters, excepting basal corrected sinus node recovery time, improved significantly after pacemaker implant.(ABSTRACT TRUNCATED AT 250 WORDS)