Accuracy of Pancreatic Stone Protein for diagnosis of sepsis in children admitted to pediatric intensive care or high-dependency care: a pilot study

BACKGROUND

Pancreatic Stone Protein (PSP) is one of the most promising diagnostic and prognostic markers. The aim of the study was to assess the accuracy of PSP, compared to C-Reactive Protein (CRP), and Procalcitonin (PCT) for sepsis diagnosis in pediatric patients. Furthermore, we explored the correlation of PSP levels with sepsis severity and organ failure measured with PELOD-2 score.

METHODS

Forty pediatric patients were enrolled following admission to pediatric intensive care, high dependency care or pediatric ward. PSP blood levels were measured in Emergency Department (nanofluidic point-of-care immunoassay; abioSCOPE, Abionic SA, Switzerland) on day 1, 2, 3, 5 and 7 from the onset of the clinical signs and symptoms of sepsis or SIRS. Inclusion criteria were: 1) patient age (1 month to 18 years old), 2) signs and symptoms of SIRS, irrespective of association with organ dysfunction. Exclusion criteria were: 1) hemato-oncological diseases and/or immunodeficiencies, 2) pancreatic diseases.

RESULTS

Septic patients showed higher PSP levels than those with non-infectious systemic inflammation. The optimal cut-off in diagnosis of sepsis for PSP at day 1 was 167 ng/ml resulted in a sensitivity of 59% (95% IC 36%-79%) and a specificity of 83% (95% IC 58%-96%) with an AUC of 0.636 for PSP in comparison to AUC of 0.722 for PCT and 0.503 for C-RP. ROC analysis for outcome (survival versus no survival) has showed AUC 0.814 for PSP; AUC 0.814 for PCT; AUC of 0.657 for C-RP.

CONCLUSIONS

PSP could distinguish sepsis from non-infectious systemic inflammation; however, our results need to be confirmed in larger pediatric population.

Testicular volume in 268 children and adolescents followed-up for childhood obesity-a retrospective cross-sectional study

CONTEXT

Prevalence of obesity in childhood has increased over the past few decades. The impact of obesity and of obesity-related metabolic disorders on testicular growth is unknown.

OBJECTIVE

To evaluate the impact of obesity, hyperinsulinemia, and insulin resistance on testicular volume (TV) in pre-pubertal (<9 years), peri-pubertal (9-14 years), and post-pubertal (14-16 years) periods.

METHODS

We collected data on TV, age, standard deviation score (SDS) of the body mass index (BMI), insulin, and fasting glycemia in 268 children and adolescents followed-up for weight control.

RESULTS

Peri-pubertal boys with normal weight had a significantly higher TV compared to those with overweight or obesity. No difference was found in the other age ranges when data were grouped according to BMI. Pre- and post-pubertal children/adolescents with normal insulin levels had significantly higher TV compared to those with hyperinsulinemia. Peri-pubertal boys with hyperinsulinemia had significantly higher TV compared to those with normal insulin levels. Post-pubertal adolescents with insulin resistance had lower TV and peri-pubertal boys had higher TV compared to those without insulin resistance. No difference was found in pre-puberty.

CONCLUSIONS

Closer control of the body weight and the associated metabolic alterations in childhood and adolescence may maintain testicular function later in life.

An ISB-consistent Denavit-Hartenberg model of the human upper limb for joint kinematics optimization: validation on synthetic and robot data during a typical rehabilitation gesture

Several biomedical contexts such as diagnosis, rehabilitation, and ergonomics require an accurate estimate of human upper limbs kinematics. Wearable inertial measurement units (IMU s) represent a suitable solution because of their unobtrusiveness, portability, and low-cost. However, the time-integration of the gyroscope angular velocity leads to an unbounded orientation drift affecting both angular and linear displacements over long observation interval. In this work, a Denavit-Hartenberg model of the upper limb was defined in accordance with the guidelines of the International Society of Biomechanics and exploited to design an optimization kinematics process. This procedure estimated the joint angles by minimizing the difference between the modelled and IMU-driven orientation of upper arm and forearm. In addition, reasonable constraints were added to limit the drift influence on the final joint kinematics accuracy. The validity of the procedure was tested on synthetic and experimental data acquired with a robotic arm over 20 minutes. Average rms errors amounted to 2.8 deg and 1.1 for synthetic and robot data, respectively. Clinical Relevance - The proposed method has the potential to improve robustness and accuracy of multi-joint kinematics estimation in the general contexts of home-based tele-rehabilitation interventions. In this respect adoption of multi-segmental kinematic model along with physiological joint constraints could contribute to address current limitations associated to unsupervised analysis in terms of monitoring and outcome assessment.

Circulating microRNAs as novel non-invasive biomarkers of paediatric celiac disease and adherence to gluten-free diet

Background

Celiac Disease (CD) is a multifactorial autoimmune enteropathy (with a prevalence of approximately 1% worldwide) that exhibits a wide spectrum of clinical, serological and histological manifestations. For the diagnosis of paediatric CD, the gold standard is the combination of serological tests (with high TGA-IgA values greater than 10 times the upper limit of normal) and duodenal biopsy (with a positive TGA-IgA but low titer). Therefore, a diagnostic test that totally excludes an invasive approach has not been discovered so far and the discovery of novel biological markers would represent an undoubted advantage for the diagnosis of CD and prognostic evaluation. MicroRNAs (miRNAs), small non-coding RNAs (18–22 nucleotides) that regulate gene expression at post-transcriptional level and play important roles in many biological processes, represent a novel class of potential disease biomarkers. Their presence in biological fluids (i.e., serum, plasma, saliva, urine) provides the opportunity to employ circulating miRNAs as novel non-invasive biomarkers.

Methods

In our prospective observational study, we examined the expression of circulating miRNAs in a cohort of CD patients (both at diagnosis and on gluten-free diet, respectively referred as CD and GFD) compared to healthy controls. By small RNA-Seq we discovered a set of circulating miRNAs that were further validated by qPCR with specific assays.

Findings

We found that out of the 13 miRNAs able to discriminate the three groups (i.e., CD, GFD and controls), three of them, namely miR-192-5p, miR-215-5p and miR-125b-5p (alone or in combination), were able to discriminate these three groups with high accuracy and specificity.

Interpretation

Our conclusions emphasize that these circulating miRNAs can be employed not only for the diagnosis of CD patients with a low TGA-IgA titer but also to monitor the adherence to a gluten-free diet by CD patients. In conclusion, we suggest the use of the circulating miRNAs identified in this work as a novel diagnostic and follow-up tool for paediatric CD.

Funding

This work was supported by Fondazione Celiachia Onlus (FC) Grant n° 018/FC/2013 and by Italian Ministry of Health (Ricerca Corrente).

A wearable multi-sensor system for real world gait analysis

Gait analysis is commonly performed in standardized environments, but there is a growing interest in assessing gait also in ecological conditions. In this regard, an important limitation is the lack of an accurate mobile gold standard for validating any wearable system, such as continuous monitoring devices mounted on the trunk or wrist. This study therefore deals with the development and validation of a new wearable multi-sensor-based system for digital gait assessment in free-living conditions. In particular, results obtained from five healthy subjects during lab-based and real-world experiments were presented and discussed. The in-lab validation, which assessed the accuracy and reliability of the proposed system, shows median percentage errors smaller than 2% in the estimation of spatio-temporal parameters. The system also proved to be easy to use, comfortable to wear and robust during the out-of-lab acquisitions, showing its feasibility for free-living applications.

Impact of exclusive e-cigarettes and heated tobacco products use on muco-ciliary clearance

Background:

Tobacco smoking impairs mucociliary clearance (MCC) efficiency as shown by prolonged saccharin test transit time (STTT). Avoiding exposure to tobacco smoke from combustible cigarettes may restore MCC function and former smokers have been shown to exhibit similar STTT as never smokers. The impact on STTT of switching from smoking to combustion-free tobacco products such as e-cigarettes (ECs) and heated tobacco products (HTPs) is not known.

Methods:

We report STTT of exclusive EC and HTP users. Test results were compared with those obtained in current, former, and never smokers.

Results:

STTT were obtained from 39 current, 40 former, 40 never smokers, and from 20 EC and 20 HTP users. Comparison of STTT values showed significant difference among the five study groups (p < 0.00001) with current smokers having a median [interquartile range (IQR)] STTT of 13.15 min, which was significantly longer compared with that of all other study groups. In particular, compared with former (7.26 min) and never smokers (7.24 min), exclusive EC users and exclusive HTP users had similar STTT at 7.00 and 8.00 min, respectively.

Conclusion:

Former smokers who have switched to exclusive regular use of combustion-free nicotine delivery systems (i.e., ECs and HTPs) exhibit similar saccharin transit time as never and former smokers. This suggests that combustion-free nicotine delivery technologies are unlikely to have detrimental effects on MCC function.

Monthly fluctuations in 25-hydroxy-vitamin D levels in day and rotating night shift hospital workers

PURPOSE

Epidemiological studies have suggested that indoor hospital employees, either day or night shift workers, are at high risk of metabolic and cardiovascular diseases. Interestingly, previous reports have also described a higher prevalence of vitamin D (25OHD) deficiency among these workers. However, few studies have determined the monthly variations in 25OHD levels in indoor hospital employees.

METHODS

To address this lack of knowledge, in 2018, during the periodic health surveillance checks at the Service of Occupational Medicine, we measured 25OHD levels in a group of indoor hospital workers (88 rotating night shift workers vs 200 day workers). Each participant received a single annual health surveillance check.

RESULTS

The mean levels of 25OHD were consistently below the lower limit of the normal range in both groups throughout the year. Only in the summer, day workers but not rotating night shift workers (mean 25.9 ± 11.3 ng/ml vs 23.1 ± 9.1 ng/ml; p = 0.042) showed levels significantly higher than those in the other seasons. This difference remained statistically significant even after correction for study covariates [β = -  1.649 (CI - 0.283/- 3.482), p = 0.039]. A cosinor analysis confirmed that the difference in the 25OHD levels between groups was present later in the year.

CONCLUSIONS

We found that relatively young healthy hospital workers, especially those with rotating night shifts, in the absence of significant metabolic risk factors, have a high risk of 25OHD deficiency/insufficiency. Because 25OHD deficiency may lead to a progression to more severe conditions such as osteoporosis or bone fractures, our results should be verified in larger cohorts including different ancestries.

DoMoMEA: a Home-Based Telerehabilitation System for Stroke Patients

After a cerebral stroke, survivors need to follow a neurorehabilitation program including exercises to be executed under a therapist's supervision or autonomously. Technological solutions are needed to support the early discharge of the patients just after the primary hospital treatments, by still providing an adequate level of rehabilitation. The DoMoMEA Project proposes a fully-wearable m-health solution able to administer a neurorehabilitation therapy in the patient's home or every other place established by the patient for a rehabilitation session. The exploitation of magneto-inertial measurement units only, wirelessly connected to an Android-operated device, provides robustness to different operating conditions and immunity to optical occlusion problems, compared to RGB-D cameras. Patients' engagement is fostered by the exploitation of the exergame version of the ten rehabilitation exercises, implemented in Unity 3D. Store-and-forward telemonitoring features, supported by cloud-based storage and by a web application accessible from anywhere by medical personnel and patients, enable constant transparent monitoring of the rehabilitation progresses. The clinical trial of the DoMoMEA telerehabilitation system will involve 40 post-stroke patients with mild impairment and will start as soon as the restrictions due to the COVID-19 pandemic will allow to enroll patients.

Accuracy of the Orientation Estimate Obtained Using Four Sensor Fusion Filters Applied to Recordings of Magneto-Inertial Sensors Moving at Three Rotation Rates

Magneto-Inertial technology is a well-established alternative to optical motion capture for human motion analysis applications since it allows prolonged monitoring in free-living conditions. Magneto and Inertial Measurement Units (MIMUs) integrate a triaxial accelerometer, a triaxial gyroscope and a triaxial magnetometer in a single and lightweight device. The orientation of the body to which a MIMU is attached can be obtained by combining its sensor readings within a sensor fusion framework. Despite several sensor fusion implementations have been proposed, no well-established conclusion about the accuracy level achievable with MIMUs has been reached yet. The aim of this preliminary study was to perform a direct comparison among four popular sensor fusion algorithms applied to the recordings of MIMUs rotating at three different rotation rates, with the orientation provided by a stereophotogrammetric system used as a reference. A procedure for suboptimal determination of the parameter filter values was also proposed. The findings highlighted that all filters exhibited reasonable accuracy (rms errors <; 6.4°). Moreover, in accordance with previous studies, every algorithm's accuracy worsened as the rotation rate increased. At the highest rotation rate, the algorithm from Sabatini (2011) showed the best performance with errors smaller than 4.1° rms.

P2801Hard events after orsiro sirolimus-eluting stent (HEROES) in STEMI: a multicenter registry

Background

Primary percutaneous coronary intervention (pPCI) using drug-eluting stents (DES) is the treatment of choice for the ST segment elevation Myocardial infarction (STEMI). Specific DES platforms, as well the strategies used to control drug release, may influence mid-to-long term pPCI success rate.

Orsiro, a third generation hybrid sirolimus eluting stent with a biodegradable polymer, may potentially cause less stent malapposition, stent-induced inflammation and mechanical damage, ultimately reducing the thrombogenicity of the stent.

Purpose

The aim of the HEROES Registry is: 1) to evaluate the safety and efficacy of the Orsiro stent in STEMI patients undergoing pPCI; 2) to capture data that reflect the “real-world” use of Orsiro stents in pPCI and provide insights into patient characteristics, comorbid conditions, patterns of care, quality of care and performance measurements.

Methods

From January 2012 to March 2018 we prospectively enrolled all patients diagnosed with STEMI who have received one or more Orsiro stents in the target vessel of pPCI at 9 Italian centres.

The primary end-point of the study was a device-oriented composite end-point (DOCE) of cardiac death, any myocardial infarction (MI) clearly attributable to the intervention culprit vessel (TVMI) and ischemic-driven target lesion revascularization (ID-TLR) at 1-year follow up.

Secondary end-points were: 1) DOCE at 6-month and 3-year follow-ups; 2) any definite/probable stent thrombosis; 3) any TIMI major bleeding (in-hospital, within 7 days after pPCI and at follow-up).

Results

Study cohort comprised 338 patients with a mean age of 64.9±12.0 years; 255 (75.4%) were men, 69 (20.4%) had diabetes and 59 (17.5%) chronic kidney disease. Median follow-up was 10.5 (range 0–67) months. Culprit vessel was the left anterior descending (LAD) in 167 (49.4%), right coronary (RCA) in 97 (28.7%), left circumflex artery (LCX) in 42 (12.4%) and other vessels in 32 (9.5%). Multivessel disease was present in 178 (52.7%); 106 (31.4%) had bifurcation lesion as a culprit. In 155 (45.9%) the culprit lesion was proximal, in 154 (45.6%) mid-vessel. Stent per lesion ratio was 1.3±0.6. Thrombus grade was 0–2 in 236 (69.8%) and 3–5 in 102 (30.2%).

At 1-year follow-up we observed a 4.4% cumulative incidence of DOCE, consisting of 13 (3.8%) cardiac deaths, 1 (0.3%) TVMI and 1 (0.3%) ID-TLR. Definite stent thrombosis occurred in only 1 (0.3%) patient during hospital stay. There were only 4 major bleedings (1.2%), all during follow-up.

Kaplan-Meier analysis showed a DOCE-free survival at 6 months of 95.9%, and at 1 and 3 years of 95.6 and 95%, respectively.

DOCE-free survival curve

Conclusions

Orsiro stent seems to be effective and safe in contemporary pPCI. The optimal features of Orsiro contribute to the few adverse events observed during follow-up and to an event-free survival that compares favorably with similar registries of modern DES.

Sputum proteomic signature of gastro-oesophageal reflux in patients with severe asthma

Gastro-oesophageal reflux disease (GORD) has long been associated with poor asthma control without an established cause-effect relationship. 610 asthmatics (421 severe/88 mild-moderate) and 101 healthy controls were assessed clinically and a subset of 154 severe asthmatics underwent proteomic analysis of induced sputum using untargeted mass spectrometry, LC-IMS-MS^E. Univariate and multiple logistic regression analyses (MLR) were conducted to identify proteins associated with GORD in this cohort. When compared to mild/moderate asthmatics and healthy individuals, respectively, GORD was three- and ten-fold more prevalent in severe asthmatics and was associated with increased asthma symptoms and oral corticosteroid use, poorer quality of life, depression/anxiety, obesity and symptoms of sino-nasal disease. Comparison of sputum proteomes in severe asthmatics with and without active GORD showed five differentially abundant proteins with described roles in anti-microbial defences, systemic inflammation and epithelial integrity. Three of these were associated with active GORD by multiple linear regression analysis: Ig lambda variable 1-47 (p = 0·017) and plasma protease C1 inhibitor (p = 0·043), both in lower concentrations, and lipocalin-1 (p = 0·034) in higher concentrations in active GORD. This study provides evidence which suggests that reflux can cause subtle perturbation of proteins detectable in the airways lining fluid and that severe asthmatics with GORD may represent a distinct phenotype of asthma.

Translating the combination of gene therapy and tissue engineering for treating recessive dystrophic epidermolysis bullosa

The combination of gene therapy and tissue engineering is one of the most promising strategies for the treatment of recessive dystrophic epidermolysis bullosa (RDEB). RDEB is a rare genetic disease characterised by mutations in the COL7A1 gene, encoding type VII collagen (COLVII), which forms anchoring fibrils at the dermal-epidermal junction of the skin. This disease causes severe blistering and only palliative treatments are offered. In this study, the base of a strategy combining gene therapy and a tissue-engineered skin substitute (TES), which would be suitable for the permanent closure of skin wounds, was set-up. As a high transduction efficiency into fibroblasts and/or keratinocytes seems to be a prerequisite for a robust and sustained correction of RDEB, different envelope pseudotyped retroviral vectors and the transduction enhancer EF-C were tested. When green fluorescent protein (GFP) was used as a reporter gene to evaluate the retroviral-mediated gene transfer, the fibroblast infection efficiency was 30 % higher with the Ampho pseudotyped vector as compared with the other pseudotypes. At least a 3.1-fold and a 1.3-fold increased transduction were obtained in fibroblasts and keratinocytes, respectively, with EF-C as compared with polybrene. A continuous and intense deposit of haemagglutinin (HA)-COLVII was observed at the dermal-epidermal junction of self-assembled TESs made of cells transduced with a HA-tagged COL7A1 vector. Furthermore, HA-tagged basal epidermal cells expressing keratin 19 were observed in TESs, suggesting stem cell transduction. This approach could be a valuable therapeutic option to further develop, in order to improve the long-term life quality of RDEB patients.

Bleeding after invasive procedures is rare and unpredicted by platelet counts in cirrhotic patients with thrombocytopenia

BACKGROUND

In cirrhotics with low circulating platelets (PLT), restoration of normal cell counts has been traditionally recommended before invasive procedures. However, there is neither consensus on the PLT transfusion threshold nor evidence of its clinical efficacy.

PATIENTS

In order to fill this gap of knowledge, we prospectively collected and analyzed data on circulating PLT counts [and International Normalized Ratio (INR)] values in a case series of 363 cirrhotics scheduled to undergo invasive investigations. PLT and/or fresh-frozen plasma (FFP) units were infused at the discretion of the attending physician, and the occurrence of post-procedural bleeding was related to pre-and post-infusion results.

RESULTS

852 Procedures were carried out in 363 cirrhotics sub-grouped according to the Child-Pugh-Turcotte (CPT) classification (class A/B/C: 124/154/85). The infusion of PLT and/or FFP improved only marginally circulating PLT counts and INR values. Ten post-procedural bleeds occurred in the whole case series, i.e. 1 episode every 85 procedures or every 36 patients. Post-procedural bleeding was unrelated to the PLT counts, to the degree of INR abnormalities, nor to the CPT classes, but was more frequent in patients who underwent repeated investigations. In the 10 patients with the most profound alterations in PLT and/or INR values, no post-procedural bleeding occurred.

CONCLUSIONS

In cirrhotic patients with low PLT and/or abnormal INR values undergoing invasive investigations, post-procedural bleeding was rare and unpredicted by PLT counts or abnormal INR values. In particular, the recommendation to infuse platelets when counts are <50×10³/L is not substantiated by this case series of cirrhotic patients.

Abstract P4-21-11: T-DM1 in HER2 positive advanced breast cancer patients: Real world practice from a multicenter observational study

Background: T-DM1 showed remarkable activity in metastatic HER-2 positive breast cancer (mBC) and it was recently approved for clinical use in patients (pts) who previously failed Trastuzumab- and Taxanes-based therapies. Currently, little is known on the performance of T-DM1 in a “real life” scenario. Therefore, we investigated effectiveness and safety of T-DM1 in Italian daily practice.

Methods: Pts baseline characteristics and clinical outcome of pts with HER-2 positive mBC treated with T-DM1 between 2013 and 2015 at 20 Italian Institutions were retrospectively collected and analyzed.

Results: 300 pts were included in our analysis. Median age was 51 years (27-78); visceral metastases were present in 204 (68%) pts and brain metastases in 86 (29%). It is noteworthy that 111 (37%) pts received T-DM1 as pure second line, 83 (28%) as third line and 96 (32%) as further lines. Moreover 10 (3%) pts had T-DM1 as first line because disease recurrence occurred during or adjuvant trastuzumab of within 6 months of its completion. The overall response rate (ORR) was 40%, global disease control rate (gDCR) 64%, median progression-free survival (PFS) 7.0 months (C.I.95%: 5.6-8.4) and overall survival (OS) at 2 years 63%. Pts with 1, 2 and 3 or more metastatic site had OS at 2 years of 87%, 67% and 46%, respectively (p&lt;0.0001). When T-DM1 was given as second line the PFS was 8.0 months and beyond second-line was 6.8 months. Interestingly, for 38 (13%) pts who progressed after Pertuzumab-plus trastuzumab and taxanes as first line treatment, ORR and gDCR were similar to pertuzumab-naïve patients (38% and 62%, respectively) However PFS was 5.0 months (C.I.95%: 4.3-5.7) compared to 9.0 (95% C.I. 5.5-12.4) achieved in pts not receiving a previous pertuzumab-based treatment. Most frequent grade ≥3 toxicities were thrombocytopenia (2.6%), alopecia (2.1%), hypertransaminasemia (2.2%), neutropenia (1.3%), asthenia (1.3%) and diarrhea (0.4%).

Conclusions: To our knowledge, this is the first real life, multicenter retrospective analysis evaluating efficacy and safety of T-DM1 in pretreated HER-2 positive mBC pts. We observed remarkable results in terms of PFS and OS, especially when T-DM1 was given early in the course of metastatic disease. Shortened PFS in patients progressing after pertuzumab suggest further analyses to better define possible molecular mechanisms of cross-resistences between two molecules. As a whole there was no evidence of significant or unexpected toxicities. Although these findings should be taken with caution due to the retrospective analysis and the different lines of previous treatment considered, we confirmed the potential therapeutic role of T-DM1 across a heterogeneous population of HER-2 positive mBC patients. The final analysis will be presented to the meeting.

Citation Format: Fabi A, De Laurentiis M, Caruso M, Valle E, Moscetti L, Santini D, Cannita K, Carbognin L, Ciccarese M, Rossello R, Arpino G, Leonardi V, Montemurro F, La Verde N, Generali DG, Zambelli A, Scandurra G, Russillo M, Paris I, D'Ottavio AM, Filippelli G, Giampaglia M, Stani S, Fabbri A, Alesini D, Giannarelli D, Cognetti F. T-DM1 in HER2 positive advanced breast cancer patients: Real world practice from a multicenter observational study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-11.

Cytokine modulation in patients with idiopathic pulmonary fibrosis undergoing treatment with steroids, immunosuppressants, and IFN-γ 1b

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease of unknown etiology and pathogenic mechanisms. From an etiopathogenic point of view, alveolar macrophages play a key role in accumulation of fibroblasts and deposition of collagen and extracellular matrix by releasing specific cytokines and inflammatory mediators. IPF seems to be also associated with circulating fibrocytes, which might be involved with an abnormal pulmonary vascular repair and remodeling. Based on its hypothesized pathologic mechanisms, anti-inflammatory, anti-fibrotic and immunosuppressive therapies are often used. For these reasons, Interferon-g (IFN-g) has been used to exploit its activity on macrophages and fibroblasts. The aim of this study was to investigate the response to corticosteroids and/or IFN-g 1b treatments based on pulmonary function tests and on inflammatory cytokine patterns of expression on bronchoalveolar lavage (BAL), at baseline and during and after the therapies. Unlike previous studies, we analyzed a period of therapy longer than 1 year. Our results demonstrated the effectiveness of IFN-γ in a group of IPF patients in whom the treatment was prolonged for over a year. These data suggest a positive role of IFN-γ; treatment in patients in the initial stage of the disease.

The quantum CP-violating kaon system reproduced in the electronic laboratory

The equivalence between the Schrödinger dynamics of a quantum system with a finite number of basis states and a classical dynamics is realized in terms of electric networks. The isomorphism that connects in a univocal way both dynamical systems was applied to the case of neutral mesons, kaons in particular, and the class of electric networks univocally related to the quantum system was analysed. Moreover, under CPT invariance, the relevant ϵ parameter that measures CP violation in the kaon system is reinterpreted in terms of network parameters. All these results were explicitly shown by means of both a numerical simulation of the implied networks and by constructing the corresponding circuits.

Contributed Review: Review of thermal methods for space charge measurement

The space charge accumulation phenomenon has garnered great interest over the last two decades because of the increased use of direct current in high voltage electrical systems. In this context, a significant relevance has been achieved by the thermal methods, used for solid dielectrics. This paper presents a review of this non-destructive measurement system used for the measurement of space charge. The thermal pulse method, the thermal step method, and the laser intensity modulation method are described. For each configuration, the principle of operation, the thicknesses analyzed, and the spatial resolution are described, reporting also the main related applications.

A combined approach for predicting the cytotoxic effect of drug-nanoaggregates

We present a combined spectroscopic and computational approach aimed to elucidate the mechanism of formation and activity of etoposide nanoaggregates upon release from dextran-etoposide conjugates. Etoposide is an anticancer drug that inhibits cell growth by blocking Topoisomerase II, the key enzyme involved in re-ligation of the DNA chains during the replication process. In silico and spectroscopic analysis indicate that released etoposide nanoaggregates have a different structure, stability, and bioactivity, which depend on the pH experienced during the release. Molecular dynamics simulation and in silico docking of etoposide dimers suggest that the aggregation phenomena inhibit etoposide bioactivity, yet without drastically preventing Topoisomerase II binding. We correlated the diminished cytotoxic activity exerted by dextran-etoposide conjugates on the A549 lung cancer cells, compared to the free drug, to the formation and stability of drug nanoaggregates.

Effect of low energy light irradiation by light emitting diode on U937 cells

Photobiomodulation (PBM) can induce a set of different biological modulators either in vitro or in vivo. Experimental evidence has highlighted the role of light effects on the mechanisms related to inflammation, apoptosis and autophagy. The goal of this project was the evaluation of PBM on U937, an established cell line of histiocytic lymphoma origin. Several aspects of modulation of proinflammatory pathways were analyzed and autophagic and proapoptotic mechanisms related to low laser light exposure of cells were studied. As a source of low energy light emission, we used an NIR-LED device, characterized by an 880 nm-wavelength as light source. Flow cytometry analysis was performed on supernatants of controls and treated U937 cells to detect inflammatory cytokine levels. In order to evaluate NF-kB and caspase3 expressions, Western blot analysis was performed according to standard procedures. In this report, we show the effect of PBM on a monocyte/macrophage established tumor cell line (U-937). We demonstrate that LED exposure, in the presence or absence of lipopolysaccharide (LPS), activates cell degranulation, increased expression of Interleukin-8 (IL-8) and modulation of beta galactosidase activity. Evidence shows that the well-known pro-inflammatory nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) and the apoptotic marker (caspase3/cleaved-caspase3 ratio) are up-regulated in response to a proinflammatory biochemical pathway.

Comparative molecular analysis of bacterial species associated with periodontal disease

Periodontal disease is an inflammatory disorder affecting the supporting teeth structures, including gingiva, periodontal ligament and alveolar bone, causing loss of connective tissue, reabsorption of alveolar bone and formation of periodontal pockets. The aim of this study is to find a correlation between bacterial growth and periodontal disease. Fifty-seven patients aged between 21 and 65 years, median age 46 years, were enrolled. According to gingival pocket depth, ranging from 3 to 7 mm, patients were divided into two groups: the first (30 patients, 53%) with deep pockets ³ 5 mm and the second (27 patients, 47%) less than 5 mm. The samples taken were processed for microbiological analysis by absolute quantitative real-time Taq-Man technique. Patients affected by periodontal disease were 32 (56%) and patients with gingival bleeding were 35 (61%). This data showed that the presence, the type and the bacterial load in gingival pockets were strongly correlated with gingival depth, periodontal disease and gingival bleeding. Quantitative microbiological analysis is a key point to improve patient compliance, allowing to choose the specific antibiotic treatment. avoiding antibiotic resistance and ensuring the successful outcome of therapy for periodontal disease.

Multilocus sequence typing of Arcobacter butzleri isolates collected from dairy plants and their products, and comparison with their PFGE types

AIMS

The present study aimed to determine, by multilocus sequence type (MLST), the heterogeneity level of Arcobacter butzleri isolates and to compare MLST and pulsed-field gel electrophoresis (PFGE) in terms of discriminatory power (DI) as well as unidirectional and bi-directional concordance.

METHODS AND RESULTS

Arcobacter butzleri isolates (N = 133) from dairy products and environmental samples, collected from dairy plants, were characterized by MLST and PFGE with SacII and classified in 29 sequence types (STs), 47 PFGE and 62 type strains (TS). Among the 119 alleles, 19 were previously unreported and the same for all the STs but two. A significant linkage disequilibrium was detected when the complete ST data set was analysed The DIs of MLST, PFGE and their combination were 0·937, 0·953 and 0·965 respectively. The adjusted Wallace coefficients between MLST and PFGE as well as PFGE and MLST were 0·535 and 0·720 respectively; the adjusted Rand coefficient was 0·612.

CONCLUSIONS

The A. butzleri studied population showed recombination to some degree. PFGE showed a DI higher than MLST. Both methods presented good concordance. The TS analysis seems to show persistence of the same strain on time and possible cross-contaminations between food and environmental sites.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides insights in the A. butzleri population found in raw milk, cheese, and dairy production plants. The data suggest that MLST and PFGE genotypes correlate reasonably well, although their combination results in optimal resolution.

Equivalent Markov processes under gauge group

We have studied Markov processes on denumerable state space and continuous time. We found that all these processes are connected via gauge transformations. We have used this result before as a method to resolve equations, included the case in a previous work in which the sample space is time-dependent [Phys. Rev. E 90, 022125 (2014)]. We found a general solution through dilation of the state space, although the prior probability distribution of the states defined in this new space takes smaller values with respect to that in the initial problem. The gauge (local) group of dilations modifies the distribution on the dilated space to restore the original process. In this work, we show how the Markov process in general could be linked via gauge (local) transformations, and we present some illustrative examples for this result.

GH therapy in transition age: state of the art and future perspectives

Growth hormone (GH) has been recently approved by the Italian Health Authorities for use in transition patients with childhood onset-growth hormone deficiency (CO-GHD). GH in addition to promote linear growth influences several key metabolic processes. In particular, in the transition period, from late adolescent to early adulthood, GH plays an important role in the achievement of a complete somatic development including body composition, muscle mass maturation, full skeletal mineralization and reproductive maturation, as well as in the prevention of metabolic and cardiovascular risk. Therefore, GH replacement should be restarted if a GH stimulation test at the re-evaluation fulfills established criteria. Endocrinologists experienced in the care of GHD adolescent patients held a workshop in Rome, Italy in July 2012 to review in detail the literature data and compare experiences of five Italian endocrinological centers on the negative consequences of interrupting GH treatment and the positive effects of continued GH replacement on intermediary metabolism, heart, muscle, pubertal development, and bone. The aim of the meeting was to delineate the state of the art on GH therapy in transition age and provide suggestions to pediatric and adult endocrinologists for a smooth transition care.

Absence of blood type A or AB may be associated with diminished oocyte reserve

PURPOSE

To determine if blood type A protects against developing diminished oocyte reserve.

MATERIALS AND METHODS

Retrospective evaluation of incidence of blood type A (or AB) in women with normal oocyte reserve (day 3 serum follicle stimulating hormone (FSH) < or = 11 mIU/ml) vs. diminished oocyte reserve (FSH > or = 18 mIU/ml).

RESULTS

Five hundred forty-seven of 1,232 (44.4%) women with normal reserve had blood type A or AB vs. 33.8% (44/130) with diminished oocyte reserve (p = 0.027, chi-square).

CONCLUSIONS

Lack of blood type A or AB may link to some other gene that may be responsible for premature depletion of oocytes.

In vitro combined treatment with cetuximab and trastuzumab inhibits growth of colon cancer cells

OBJECTIVES

Overexpression or constitutive activation of epidermal growth factor receptors (EGFR) is involved in growth of human cancers. We investigated effects of EGFR and HER-2 blockade in colon cancer cell lines using cetuximab and trastuzumab, with the aim of developing novel approaches to cancer therapy.

MATERIALS AND METHODS

We studied effects of treatment on cell growth, cell cycle distribution, induction of apoptosis, changes in EGFR and HER-2 mRNA-protein expression and EGFR and HER-2 gene copy number in Caco-2, HT-29 and HCT-116 cells.

RESULTS

Treatment of cells resulted in no effect in one of the three cell lines and in inhibition of cell proliferation in a time- and dose-dependent manner in the other two, with modulation of EGFR and HER-2 mRNA and protein levels. Differences in sensitivity to cetuximab and trastuzumab were observed. Treatment induced specific changes in cell cycle distribution in both cell lines affected, while apoptosis was not increased. Fluorescence in situ hybridization analysis revealed abnormal copy number of two genes resulting from aneuploidy; this was not responsible for different sensitivity to combination between the two cell lines.

CONCLUSIONS

Targeting EGFR and HER-2 simultaneously could have useful applications in colorectal cancer treatment. To improve pharmacological efficacy of cetuximab and trastuzumab combination, molecular mechanisms involved in their activity need to be elucidated.

Markov-chain approach to the distribution of ancestors in species of biparental reproduction

We studied how to obtain a distribution for the number of ancestors in species of sexual reproduction. Present models concentrate on the estimation of distributions repetitions of ancestors in genealogical trees. It has been shown that it is not possible to reconstruct the genealogical history of each species along all its generations by means of a geometric progression. This analysis demonstrates that it is possible to rebuild the tree of progenitors by modeling the problem with a Markov chain. For each generation, the maximum number of possible ancestors is different. This presents huge problems for the resolution. We found a solution through a dilation of the sample space, although the distribution defined there takes smaller values with respect to the initial problem. In order to correct the distribution for each generation, we introduced the invariance under a gauge (local) group of dilations. These ideas can be used to study the interaction of several processes and provide a new approach on the problem of the common ancestor. In the same direction, this model also provides some elements that can be used to improve models of animal reproduction.

Myocardial infarction in young adults: risk factors, clinical characteristics and prognosis according to our experience

OBJECTIVES

Myocardial infarction is a relatively unusual phenomenon in young subjects. The aim if this work is to characterize the risk profile and factors influencing outcomes of these patients since it makes possible to manage prevention interventions.

PATIENTS AND METHODS

We examined cardiovascular risk factors, clinical presentation, angiographic picture and outcome of a group of young patients hospitalized for a myocardial infarction. We enrolled 121 young patients consecutively admitted to our hospital for a myocardial infarction and examined them not only at the initial stage, but also after 3 months and one year; finally a long-term telephonic follow up was performed, when possible.

RESULTS

We found some peculiarity making these patients quite different from the older ones who develop a myocardial infarction: cigarettes smoking, family history of ischemic heart disease and hyperlipidemia were the most frequent cardiovascular risk factors, while diabetes and hypertension were less represented; moreover coronary angiography showed more frequently a less extensive coronary atherosclerosis. Patients who developed a cardiovascular event at follow-up presented a significantly higher prevalence of hypertension and obesity and a significantly lower frequency of healthy coronary arteries and of previous revascularization.

CONCLUSIONS

Myocardial infarction in young adults presents several peculiarities, represented not only by the risk profile, but also by the angiographic picture and the prognosis. Considering the long life expectancy of the involved population, the essential role of preventive interventions should be strongly underlined.

Access to prenatal cytogenetic diagnosis in Catania: a retrospective survey

BACKGROUND

To determine the incidence of chromosome abnormalities (CAs) in prenatal cytogenetic diagnosis, to describe and compare indications in Italian and migrant women, and to assess the level of compliance with published national guidelines.

METHODS

A retrospective analysis of 7806 amniotic fluid samples (AFS) and 228 chorionic villi samples (CVS) was conducted.

RESULTS

Advanced maternal age was the most common indication. CAs incidence was 3.1 per 100 AFS, and 12.6 per 100 CVS. Only parental chromosome rearrangement and ultrasound abnormalities were significantly associated with CA occurrence (RR= 20.15 95%CI: 11.96-33.96; RR= 4.33; 95%CI: 2.95-6.36, respectively). Both in amniocentesis and in chorionic villi sampling CA incidence was significantly higher when performed according to the national guidelines, than for other reasons. Incidence data for trisomy 21, trisomy 18 and inversions were significantly higher than those reported in a previous Italian report.

CONCLUSIONS

Increased maternal age may explain, at least in part, the increase by time of CAs, although an excess was shown in our population independently from it. Our results show that advanced maternal age may not be sufficient as a single criterion for prenatal diagnosis, and suggesting a future revision of national clinical indications is suggested.

Vasospastic angina and scombroid syndrome: a case report

Scombroid syndrome is a fish poisoning characterised by the onset of symptoms compatible with a pseudoallergic reaction; it is rarely also responsible of signs and symptoms of acute coronary syndromes, as demonstrated in this case report.