Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults

There is a growing population of autistic adults in need of supports from a service delivery system that, at present, fails to accommodate their needs adequately and equitably. Unfortunately, there is a shortage of trained behavioral health service providers to meet the needs of young autistic adults. Quality of life (QoL), or one's perception of, and satisfaction with, life in relation to held goals and expectations, has been identified as a key outcome of interest by autistic self-advocates. By supporting autistic clients to hone their strengths and interests, integrate various aspects of their identity, identify goals, and connect to appropriate resources, providers can promote clients' self-knowledge and self-determination, in the service of improving QoL. In this Perspectives article, we offer concrete recommendations to mental health providers, including those who do not specialize in autism, with the goal of supporting implementation of evidence-based strategies that improve QoL and promote self-determination among young autistic clients.

Centering the Inner Experience of Autism: Development of the Self-Assessment of Autistic Traits

Current tools for identifying autism are critiqued for their lack of specificity and sensitivity, especially in autistic people who are older, have higher verbal ability or significant compensatory skills, and are not cisgender boys. This may reflect the following: the historical focus of autism research on White (cisgender) male, upper and middle class children; limited interest in the inner, lived experience of autism; and the predominance of a deficit-based model of autism. We report here on the first attempt of which we are aware to develop a clinical self-report measure of autistic traits as described by autistic people. We believe this is an advance in methodology because prior work in the development of autistic trait/diagnostic measures has prioritized the perspectives of nonautistic clinicians and scientists. The measure was developed under the leadership of two autistic researchers and constructed by leveraging descriptions of autism by autistic people to generate items designed to encompass the range of the autistic experience, using strength-based, accessible language. The team utilized iterative feedback from a panel of autistic experts to refine and enhance the measure, called the Self Assessment of Autistic Traits (SAAT). It is intended for people 16 years or older and uses a format that is designed to increase its accessibility and acceptability for autistic respondents. Future work will report on the preliminary psychometrics of the SAAT, with a long-term goal of advancing our understanding of the inner autistic experience and enhancing the clinical and scientific assessment of autism.

Adding the missing voice: How self-report of autistic youth self-report on an executive functioning rating scale compares to parent report and that of youth with attention deficit hyperactivity disorder or neurotypical development

LAY ABSTRACT

Executive functions are often impaired in autistic people and relate to important outcomes such as mental health, success in school and work, and quality of life. Evaluating executive functions helps autistic people, clinicians, and families identify targets for external supports and skill building. Youth self-report of executive function has not been studied, yet we know that self-report from autistic youth is key to understanding other cognitive/behavioral phenomena in autism such as anxiety, obsessions/compulsions, sensory sensitivities, and repetitive behaviors. We investigated self- and parent-report of executive function problems in 197 autistic youth without intellectual disability (ages 11-18 years), including the magnitude and profiles of executive function problems autistic youth report across subdomains of executive function. We compared autistic self-report with that of 114 youth with attention deficit hyperactivity disorder without intellectual disability and 197 neurotypical youth. We found that autistic youth report significant executive function problems compared to neurotypical youth and a distinctive profile of challenges in comparison to attention deficit hyperactivity disorder youth. Parents and their autistic children diverged regarding the magnitude of the youth's executive function difficulties, but both identify inflexibility as the most impaired executive function subdomain. Autistic youth and their parents were somewhat more concordant in their report of executive function problems than youth with attention deficit hyperactivity disorder and their parents, but only showed moderate concordance at best. These findings elevate the importance of asking autistic youth directly about their executive functioning when engaging them in assessment and intervention, or researching executive functions in autism.

Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes

OBJECTIVES

School-based interventions with parent-training components might improve access among lower-income families to effective help for children with neurodevelopmental disorders. This potential might be realized, however, only if parents perceive the interventions as acceptable and therefore engage with treatment.

METHODS

Parents (N = 124) of 3rd-5th grade students diagnosed with Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder rated the acceptability of their child's treatment (one of two culturally responsive behavioral interventions). Parent engagement was measured through attendance at parent training sessions and the extent to which they read a corresponding workbook.

RESULTS

Education and income correlated inversely with parent perceptions of treatment acceptability. Acceptability correlated positively with engagement, more strongly among lower-income families. Acceptability had an indirect effect on treatment outcome, mediated by parent engagement.

CONCLUSIONS

Treatment providers should focus on strategies to increase parent acceptability, with particular attention to improving access for lower-income families.

Review: Precision Livestock Farming technologies in pasture-based livestock systems

Precision Livestock Farming (PLF) encompasses the combined application of single technologies or multiple tools in integrated systems for real-time and individual monitoring of livestock. In grazing systems, some PLF applications could substantially improve farmers' control of livestock by overcoming issues related to pasture utilisation and management, and animal monitoring and control. A focused literature review was carried out to identify technologies already applied or at an advanced stage of development for livestock management in pastures, specifically cattle, sheep, goats, pigs, poultry. Applications of PLF in pasture-based systems were examined for cattle, sheep, goats, pigs, and poultry. The earliest technology applied to livestock was the radio frequency identification tag, allowing the identification of individuals, but also for retrieving important information such as maternal pedigree. Walk-over-weigh platforms were used to record individual and flock weights. Coupled with automatic drafting systems, they were tested to divide the animals according to their needs. Few studies have dealt with remote body temperature assessment, although the use of thermography is spreading to monitor both intensively reared and wild animals. Global positioning system and accelerometers are among the most applied technologies, with several solutions available on the market. These tools are used for several purposes, such as animal location, theft prevention, assessment of activity budget, behaviour, and feed intake of grazing animals, as well as for reproduction monitoring (i.e., oestrus, calving, or lambing). Remote sensing by satellite images or unmanned aerial vehicles (UAVs) seems promising for biomass assessment and herd management based on pasture availability, and some attempts to use UAVs to monitor, track, or even muster animals have been reported recently. Virtual fencing is among the upcoming technologies aimed at grazing management. This system allows the management of animals at pasture without physical fences but relies on associative learning between audio cues and an electric shock delivered if the animal does not change direction after the acoustic warning. Regardless of the different technologies applied, some common constraints have been reported on the application of PLF in grazing systems, especially when compared with indoor or confined livestock systems. Battery lifespan, transmission range, service coverage, storage capacity, and economic affordability were the main factors. However, even if the awareness of the existence and the potential of these upcoming tools are still limited, farmers' and researchers' demands are increasing, and positive outcomes in terms of rangeland conservation, animal welfare, and labour optimisation are expected from the spread of PLF in grazing systems.

Meeting the needs of autistic adults in Qatar: Stakeholder perspectives on gaps in services and priorities for future programming

LAY ABSTRACT

Qatar is expanding the services that it offers for autistic people, but these services focus mainly on diagnosing and treating young children. Because there are not enough autism providers in Qatar and few opportunities for autistic youth to participate in the community, more and more autistic teens and young adults have unmet needs during their transition to adulthood. The goal of this study was to conduct a needs assessment of transition-age autistic youth in Qatar and their families in order to inform the development of an adult respite care and support center. Respite care is a service that provides families with stress relief and time to participate in activities that are more difficult to do when their loved one with a disability is with them. The objective of this study was to use family and stakeholder input to identify the needs and preferences for respite care for autistic youth in Qatar. The project was conducted with a local research team in Qatar and a team of clinical researchers in the United States specializing in autism. Stakeholders, including parents of autistic people and providers working with individuals with autism, completed surveys and participated in focus groups. Families and providers in Qatar were very interested increasing services for young adults with autism to improve quality of life, although wanted to make sure the service providers would be reliable and trustworthy. Implications from this study may substantially improve the lives of autistic adults in Qatar.

What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills

There is growing evidence of a camouflaging effect among females with autism spectrum disorder (ASD), particularly among those without intellectual disability, which may affect performance on gold-standard diagnostic measures. This study utilized an age- and IQ-matched sample of school-aged youth (n = 228) diagnosed with ASD to assess sex differences on the ADOS and ADI-R, parent-reported autistic traits, and adaptive skills. Although females and males were rated similarly on gold-standard diagnostic measures overall, females with higher IQs were less likely to meet criteria on the ADI-R. Females were also found to be significantly more impaired on parent reported autistic traits and adaptive skills. Overall, the findings suggest that some autistic females may be missed by current diagnostic procedures.

Can innovations in traditional pork products help thriving EU untapped pig breeds? A non-hypothetical discrete choice experiment with hedonic evaluation

The EU is supporting measures that stimulate enhanced value-added products in order to conserve local and threatened livestock breeds. Several Traditional Pork Products (TPP) and Innovative Traditional Pork Products (ITPP) with health innovations from four untapped pig breeds in Spain (Porc Negre Mallorquí), Croatia (Turopolje), Italy (Cinta Senese) and Slovenia (Krškopolje) were analysed. Consumers' "Non-hypothetical" willingness to pay (WTP) and hedonic evaluation were investigated. An integrated experimental approach using two Non-Hypothetical Discrete Choice Experiment (NH-DCE) was carried out before and after a hedonic evaluation test. Results showed that the health innovative products (ITPP) received similar and even lower WTP than the "control" products (TPP) from the untapped pig breeds. The TPP outperformed products enriched with healthy ingredients or with reduced undesirable compounds. The potential demand for traditional and "unaltered" product from the rustic pig breeds could contribute to their conservation. A market niche exists, where consumers appreciate these high-quality products and where no "add-ons" are required to enhance their uptake.

Enrichment of Cinta Senese burgers with omega-3 fatty acids. Effect of type of addition and storage conditions on quality characteristics

The most beneficial omega-3 PUFAs to human health, EPA and DHA fatty acids, are typically present in fish products, but extraneous to meat. Therefore, Cinta Senese pork burgers were added with microencapsulated (M) and bulk fish oil (F) and subjected to three storage conditions: no storage (T0), chilled (T5) and frozen storage (T30). The physico-chemical and sensory attributes of raw and cooked burgers were investigated. After storage and cooking, EPA and DHA were better preserved in M burgers than in F samples, which showed the highest TBAR values at T0 and T5, while M samples presented scores similar to the control. Panelists observed differences mainly in greasy appearance, odor intensity and cooked meat odor and flavor. The M group showed the best scores at T5 with respect to the control and F burgers. So, fish oil microencapsulation was an effective method to prevent EPA and DHA oxidation while respecting burger quality characteristics.

Fabbisogni proteici in suini Cinta Senese da 30 a 60 kg: risultati preliminari

La conoscenza del fabbisogno proteico dei suini durante la prima fase di vita è fondamentale sia per ottenere elevati tassi di crescita sia per evitare sprechi di azoto. Le razze autoctone possiedono specifici requisiti in questo senso e la letteratura è scarsa anche una razza come la Cinta Senese. Pertanto, l’effetto di diversi livelli di proteina grezza (CP) in maiali di Cinta Senese, tra 30 e 60 kg, è stata valutata nell’ambito del progetto TREASURE*. Dodici suini maschi sono stati allevati singolarmente al chiuso, alimentati con quattro diete isoenergetiche con diversi livelli di CP (18, 16, 14 e 12%) equamente distribuite tra gli animali. Gli animali, con un peso vivo medio iniziale di 27 kg, sono stati alimentati ad libitum e macellati dopo 2 mesi di prova. Alla macellazione la mezzena sinistra della carcassa è stata sezionata in sei tagli: testa, collo, lombo, spalla, prosciutto e costole. Ogni taglio è stato sezionato nei tessuti principali. Per quanto riguarda le prestazioni in vita è stato notato un tasso di crescita leggermente superiore al diminuire del livello della proteina (ADG di 0,781, 0,774, 0,755 e 0.729 kg / d, rispettivamente per 12, 14, 16 e 18% di CP), anche se solo i due livelli estremi di CP (12 vs 18%) hanno comportato differenze statistiche (P = 0,05). Le percentuali dei tagli commerciali e dei tessuti principali sono risultate simili tra le diete. La dieta con il 12% di CP può essere il compromesso ottimale per la crescita delle Cinta Cenese da 30 a 60 kg di peso vivo.

Effetto del tipo di conservazione e arricchimento in omega-3 sulla qualità di hamburger di Cinta Senese

Il contenuto di acidi grassi polinsaturi (PUFA) della carne suina di razza Cinta Senese è solo del 10-11% rispetto al contenuto di grasso totale. Inoltre, gli acidi grassi eicosapentaenoico e docosaesaenoico non sono presenti nella carne suina, mentre sono molto abbandonati nei prodotti a base di pesce. Quindi, si è addizionato olio di pesce deodorizzato, o tal quale (F) o previa microencapsulazione (M), a hamburger di Cinta Senese, al fine di migliorarne la salubrità. Gli hamburger sono stati divisi in tre gruppi e sono stati sottoposti a tre diverse condizioni di conservazione: nessuna conservazione (T0), refrigerazione (T5) e congelazione (T30). Al termine del prestabilito periodo di conservazione, il prodotto è stato cotto e sono stati analizzati il profilo acidico e l’ossidazione lipidica. Gli hamburger del gruppo M hanno mostrato una quantità significativamente più alta di PUFA sia al T0 che al T5; in particolare i PUFA omega-3 sono risultati più alti negli hamburger M per tutte e tre le modalità di conservazione. La modalità di addizione dell’olio di pesce ha avuto effetti diversi sull’ossidazione lipidica; infatti, i valori più alti sono stati registrati per i prodotti del gruppo F. Per concludere, la tecnica di microincapsulazione dell’olio di pesce ha dimostrato di riuscire a proteggere al meglio dall’ossidazione i PUFA omega-3 addizionati, migliorando e garantendo così il contenuto di questi acidi grassi nel prodotto, anche dopo la cottura.

The Chromogranin A-derived sympathomimetic serpinin depresses myocardial performance in teleost and amphibian hearts

Chromogranin A (CgA) is an acidic protein co-stored with catecholamines, hormones and neuropeptides in the secretory granules of endocrine, neuronal and other cell types (including cardiomyocytes). Proteolytic cleavage in the C terminus of CgA generates a 2.9kDa peptide named serpinin (Serp; Ala26Leu) that can be modified at its N terminus to form a pyroglutamate residue (pGlu-Serp). In the rat heart, both peptides increase contractility and relaxation through a β-adrenergic-like action mechanism. Accordingly, Serp and pGlu-Serp were proposed as novel myocardial sympatho-adrenergic modulators in mammals. On a comparative basis, here we report the actions of Serp and pGlu-Serp on myocardial contractility in three poikilotherm vertebrate species: the eel (Anguilla anguilla), the goldfish (Carassius auratus) and the frog (Rana esculenta). Using isolated working heart preparations, we show that pGlu-Serp reduces stroke volume in all species tested, while Serp reduces contractility in the frog heart, but is uneffective in eel and goldfish hearts. In the goldfish and frog hearts, pGlu-Serp activates the Nitric Oxide/cGMP pathway involving Endothelin-1 B receptors (frog) and β₃ adrenergic receptors (goldfish). pGlu-Serp-treated hearts from goldfish and frog show increased cGMP content. Moreover, the exposure of the frog heart to pGlu-Serp is accompanied by an increased expression of activated eNOS and Akt. In conclusion, this first report showing that pGlu-Serp inhibits mechanical cardiac performance in teleost and amphibians supports an evolutionary role of the CgA system, and particularly its serpinin component, in the sympatho-adrenergic control of the vertebrate heart.

Lessons learned: Engaging culturally diverse families in neurodevelopmental disorders intervention research

Low-income and ethnic minority families continue to face critical disparities in access to diagnostic and treatment services for neurodevelopmental conditions, such as autism spectrum disorder and attention deficit hyperactivity disorder. Despite the growing cultural diversity of the United States, ethnic minority children and families continue to be substantially underrepresented across research on neurodevelopmental disorders, and there is a particularly concerning lack of research on the treatment of these conditions in low-income and ethnic minority communities. Of note, there are currently no published studies on adapting autism spectrum disorder treatment for low-income Latino communities and relatively few studies documenting adapted treatments for children with attention deficit hyperactivity disorder in these communities. This article describes methodological considerations and adaptations made to research procedures using a Diffusion of Innovation framework in order to effectively recruit and engage low-income, ethnic minority, particularly Latino, families of children with neurodevelopmental disorders, in a comparative effectiveness trial of two school-based interventions for executive dysfunction.

Fibrinogen and prothrombin complex concentrate in trauma coagulopathy

BACKGROUND

Coagulopathy after injury contributes to hemorrhage and death. Treatment with specific coagulation factors could decrease hemorrhage and mortality. Our aim was to compare fibrinogen and prothrombin complex concentrate (PCC) in a rabbit model of hemorrhagic shock.

MATERIALS AND METHODS

New Zealand white rabbits were anesthetized. Blood was withdrawn to a mean arterial pressure (MAP) of 30-40 mm Hg for 30 min. Animals were resuscitated with lactated Ringer to a MAP of 50-60 mm Hg and randomized to receive 100 mg/kg of fibrinogen, PCC 25 IU/kg, or lactated Ringer. A liver injury was created. A MAP of 50-60 mm Hg was maintained for 60 min. The primary outcome was blood loss, and secondary outcomes were fluid administered and coagulopathy as measured by plasma-based tests.

RESULTS

There were eight animals in each group. Median blood loss was significantly higher in the fibrinogen group, at 122 mL (95% confidence interval [CI], 75-194), when compared with that in the control group, 35 mL (95% CI, 23-46; P value = 0.001), and the PCC group, 26 mL (95% CI, 4-54; P value = 0.002). Resuscitation fluid requirement was highest in the fibrinogen group, at 374 mL (95% CI, 274-519), and lowest in the PCC group, at 238 mL (95% CI, 212-309) (P = 0.01). Plasma-based coagulation tests were not different among groups.

CONCLUSIONS

In a rabbit model, PCC did not have a significant effect on blood loss. Fibrinogen increased blood loss and fluid requirements.

Comparison of the performances of Nero Siciliano pigs reared indoors and outdoors: 2. Joints composition, meat and fat traits

A study on the effect of rearing system on tissue composition of principal joints and chemical-physical traits of meat and subcutaneous fat, was carried out on a local pig breed. A total of 78 Nero Siciliano pigs was used; 41 pigs were reared in woods, 37 pigs were reared in pens and fed a commercial diet. Weight at slaughter was 101.9 and 88.2 kg for indoor and outdoor pigs, respectively. Means were estimated at 77 kg of live weight. At ham dissection outdoor-pigs showed higher percentages of lean (58% vs. 55%) and lower subcutaneous fat (31% vs. 34%). In Longissimus lumborum outdoor-pigs showed a higher intramuscular fat percentage (4.3% vs. 3.3%), a lower protein content (22.2% vs. 23.4%), and higher free water (9.6 vs. 7.9 cm(2)). Outdoor pigs produced more light (L(*)=50 vs. 46.7) and more yellow (b(*)=5.84 vs. 4.88) meat. Subcutaneous fat of outdoor pigs showed higher percentages of MUFA (53.3% vs. 47.2%) and lower percentages of PUFA (10.85% vs. 14.45%), no differences were found for n-3 PUFA. Outdoor-pigs had lower atherogenicity (0.48 vs. 0.53) and thrombogenicity (1.03 vs. 1.21) indices.

Quality of fresh and seasoned fat of Cinta Senese pigs as affected by fattening with chestnut

This trial was aimed to verify the effect of fattening with chestnut on carcass characteristics and on quality traits of products of Cinta Senese breed. Thirty-three Cinta Senese pigs were allotted into three groups. One group was fed a commercial feedstuff (0-CH), the other two groups were fed chestnut for one (1-CH) or three (3-CH) months. Pigs were slaughtered at 130 kg of live weight. The 1-CH group showed significantly lower pH value at 24h (P<0.05). For sample joint dissection a significant effect (P<0.05) of feeding system was found only on intermuscular fat, highest in 1-CH. A significant effect of feeding system (P<0.05) was found on physical and chemical parameters of Longissimus lumborum: the 3-CH group showed the highest values (P<0.05) of L, a, b, drip loss, cooking loss, shear force and intramuscular fat on raw meat. The 3-CH showed significantly higher level (P<0.05) of unsaturation for the highest percentage of MUFA and PUFA.

Worsening renal function and prognosis in pulmonary hypertension patients hospitalized for right heart failure

Increased central venous pressures have been associated with the development of worsening renal function (WRF), an important marker of prognosis. We sought to determine the incidence and prognostic significance of WRF in pulmonary hypertension patients (PH) with isolated right HF. A prospective study of PH clinic patients admitted to hospital for right HF. WRF was defined as a rise in creatinine of 26 μmol/L (0.3 mg/dL) within the first 48 hours of admission. A total of 32 patients were enrolled in this study, 67% of patients had moderate-severe chronic kidney disease with an eGFR ≤ 60 mL/min and 34% (n=11) developed WRF during their admission. The mean right atrial pressure was higher in patients with WRF (19 ± 7 mm Hg vs 12 ± 6 mm Hg, P=.05). A total of 36% of patients with WRF died in hospital compared to 5% in the group that did not develop WRF (OR for hospital death 13.3 ± 16, P=.03). The combined endpoint of death or readmission at 6 months was 45% in the WRF group and 43% in the group without WRF (P=.89). Significant renal dysfunction is common in patients with PH and an acute decline in renal function is an important marker of in hospital death and short term mortality in right heart failure.

The evolution of volatile compounds profile of "Toscano" dry-cured ham during ripening as revealed by SPME-GC-MS approach

The volatile compounds profile is an important feature for the characterization of dry-cured hams. Some minor typical Italian products, such as 'Toscano' ham, have been poorly studied in regards to their composition of volatile compounds. In this article, we studied the evolution of the aromatic profile of 'Toscano' dry-cured ham by solid-phase microextraction-gas chromatographic-mass spectrometry (SPME-GC-MS) with ripening. Ten right thighs were cured according to the 'Toscano' PDO protocol, sampled at 0, 1, 3, 6 and 12 months and submitted to volatile compounds analysis by SPME with a Divinylbenzene (DVB)/Carboxen/Polydimethylsiloxane (PDMS) 75-µ Stable Flex fibre. An Agilent 5975C mass selective detector (MSD) spectrometer with electron ionization (EI) source operating in scan mode within the m/z 29-350 range was used for data collection. Seven internal standards, either deuterium labeled or absent in the specimens and chosen to represent low or high boiling esters, alcohols, acids or phenols, were added to the homogenized samples and used to normalize the SPME fibre response to account for response changes upon wearing. Linear calibrations were obtained in this way for selected representative compounds. Over 60 compounds belonging to esters, aldehydes, organic acids, ketones and alcohols were identified by comparison with spectral libraries and Kovats indices. Aldehydes were the most represented chemical family, followed by organic acids, alcohols, ketones and esters. The aldehydes and ketones increased during the first 3 months, when the larger formation of volatiles occurred. For other families, the evolution over time was less evident. The principal component and discriminant analyses of the aromatic profile were effective in classifying the hams at 0, 6 or 12 months of ripening while for 1 and 3 months' samples a partial overlapping was shown. These results represent the first characterization of 'Toscano' ham and may constitute the basis to identify the best ripening time and define an analytical quality standard for this typical ham.

Enhanced nonenzymatic glycation of eye lens proteins in experimental diabetes mellitus: an approach for the study of protein alterations as mediators of normal aging phenomena

The levels of advanced nonenzymatic glycation endproducts (ACE) were investigated by spectrofluorimetry in eye lens proteins obtained from rats with experimental diabetes of 3 and 6 months duration and from normal age-matched control rats. Diabetic animals showed higher AGE levels at both times studied. However the older control animals showed protein ACE levels comparable to those of the experimental 3 months diabetic group. These data suggest that a pathological phenomenon such as enhanced nonenzymatic glycation, associated to diabetic hyperglycemia, can be considered as a process leading to an accelerated aging of proteins. Thus experimental diabetes mellitus may be used as a model to investigate physiological protein senescence.

Quantitative variations in the vaginal bacterial population associated with asymptomatic infections: a real-time polymerase chain reaction study

The real-time polymerase chain reaction (PCR) quantification of several vaginal bacterial groups in healthy women and patients developing asymptomatic bacterial vaginosis (BV) and candidiasis (CA) was performed. Statistical analysis revealed that the BV condition is characterised by a great variability among subjects and that it is associated with a significant increase of Prevotella, Atopobium, Veillonella and Gardnerella vaginalis, and a drop in Lactobacillus. On the contrary, the vaginal microflora of healthy women and patients developing CA was found to be homogeneous and stable over time.

Assessment of cyclosporine pharmacokinetic parameters to facilitate conversion from C0 to C2 monitoring in heart transplant recipients

BACKGROUND

Cyclosporine (CsA) 2-hour postdose (C2) monitoring is recommended to assess CsA exposure and predict clinical outcomes among heart transplant recipients. We correlated pharmacokinetic parameters and clinical outcomes in stable long-term heart transplant recipients monitored with C0 to develop an algorithm to convert patients from C0 to C2 monitoring.

METHODS

Paired CsA C0-C2 measurements and serum creatinine levels were obtained from 35 heart transplant recipients more than 2 years posttransplantation (mean 8.8+/-4.7 years).

RESULTS

The mean CsA dose and C0, C2, and C0/C2 ratio were 85+/-23 mg/12 hours, 123+/-41 ng/mL, 572+/-274 ng/mL and 4.8+/-2.1, respectively. C0 correlated weakly with C2 (r=.42, P=.011). The CsA dose correlated better with C2 (r=.58; P<.001) than with C0 (r=.37; P=.026). A good correlation was noted between C2 and the C2/C0 ratio (r=.73; P<.001), but none between C0 and the C2/C0 ratio. A borderline significant inverse correlation was noted between C0 and the worst endomyocardial biopsy score (r=-.34; P=.045), whereas none was noted with C2. Serum creatinine level did not correlate with either C2 or C0. Among patients with C0 within our target of 100 to 150 ug/L, six had C2 above 300 to 600 ug/L as suggested by the literature.

CONCLUSIONS

In long-term heart transplant recipients, we could not identify a single pharmacokinetic parameter that could be used to develop an algorithm to convert from C0 to C2 monitoring; however, C2 may be better than C0 for identifying patients at risk of overexposure to CsA.

Bronchial carcinoid tumours: a study on clinicopathological features and role of octreotide scintigraphy

Several authors proposed the stage at diagnosis and some histopathological features as prognostic factors of bronchial carcinoids. However, since large tumour diameters or nodal metastases are frequently associated to aggressive histology, their prognostic role is unclear. To investigate the relationships between the clinicopathological parameters at diagnosis and outcome, 21 patients were analysed. Overall 26% of the radically resected patients recurred. Recurrences and disease-specific mortality were related to atypical histology and, only in cases with typical histology, to the presence of hilar or mediastinal lymph node metastases. These prognostic factors were valuable independently of the size of the primary tumour, that was remarkably homogeneous, always less than 3 cm, thus not predictive of recurrence. Moreover we evaluated the role of somatostatin receptor scintigraphy, a diagnostic tool only preliminary studied in this field. Scintigraphy with 111In-octreotide revealed the primary tumours at diagnosis (8/8), the increase in tumour size in two unresected patients, and all the cases of recurrent or metastatic disease (5/11), sometimes before the appearance of symptoms. These results suggest the usefulness of histology and nodal status as prognostic factors in clinical practice. Somatostatin receptor scintigraphy turns out to be a powerful diagnostic tool, for an accurate staging and an early diagnosis of recurrence in bronchial carcinoids.

Pneumonia due to Leptospira spp.: results of an epidemiological and clinical study

OBJECTIVE

To evaluate the prevalence of Leptospira spp. infections in a population of in- and out-patients with community acquired pneumonia (CAP) and the incidence of leptospiral pneumonia.

DESIGN AND RESULTS

Of 176 patients infected with CAP who were evaluated for the presence of Leptospira spp. as causative agent, 10 were found positive for leptospiral antibodies (prevalence rate: 5.7%), but seroconversion was observed in only one case (incidence rate: 0.6%). The patient had had recent contact with possibly contaminated water. She had pulmonary involvement and signs of mild hepatic damage, but recovered fully.

CONCLUSION

The authors highlight the importance of testing for leptospirosis in case of pneumonia in endemic areas where the more common causative pathogens for CAP can not be documented and when initial empiric therapy is ineffective.

Unusual case of pulmonary rickettsiosis in non-Hodgkin's lymphoma

A case report of boutonneuse fever with pulmonary complications in a patient with non-Hodgkin's lymphoma (NHL) is described. The patient was hospitalized for persistent hypertermia and marked dyspnea, with radiographic findings of bilateral involvement of the lungs. The confirmation of the diagnosis was obtained by means of serum analyses (Weil-Felix serodiagnosis and IFA); the patient responded to doxycycline with progressive improvement of her general health condition. In this case the occurrence of a NHL could justify the lower reactivity and the facilitated diffusion of rickettsiosis in the patient.

Langerhans' cell granulomatosis and Hodgkin's lymphoma. Report of a case

A 48-year-old female with a history of accentuated dyspnea, pleural thickening in anteromedial portion with left patchy parenchymal shadowing invading adjoining parasternal structure of the rib cage, presented 13 months later marked superclavicular, anterior mediastinic and parahilar left lymphadenopathy. Open surgical biopsies on the pleural lesion invading the hypodermic tissues of parasternal region showed morphological and immunocytochemical patterns of Langerhans' cell histiocytosis (LCH). 13 months later the superclavicular lymph node biopsy diagnosed Hodgkin's lymphoma (HD), mixed cellularity type II, stage AE. On a total of 29 cases with association of LCH and HD, the described case in the second case that shows morphologically demonstrated LCh with subsequent development of HD. It is postulated that the development of HD in a patient with LCH, might represent malignant evolution of this hyperplastic process.

Community-acquired pneumonia: is there difference in etiology between hospitalized and out-patients?

Since March 1991 a prospective 1-year study of patients with community-acquired, radiologically verified, pneumonia (CAP) was performed at the Divisione Pneumologica, Ospedali Riuniti Bergamo, and at the Centro Pneumo-Allergologico, Bergamo, Italy. The study included 119 out-patients and 60 in-patients, with a median age of 37.4 and 49.8 years respectively. There were not statistically significant differences between the patients included with respect to the various months. The most common underlying illnesses were: chronic obstructive pulmonary disease (20.7%), diabetes (7.3%) and malignancy (3.4%). We found a quite different etiology of CAP between out- and in-patients. By far the most common etiologic agent in out-patients was Mycoplasma pneumoniae (32.8%), while in in-patients was Legionella pneumophila (11.7%). 5 patients had a double infection. There were no distinctive clinical and radiological features found to be diagnostic for any etiologic agent. Hospital stay averaged 12.1 days. 35% of the patients included in the study were been treated by beta-lactam, often parenterally, nevertheless 88 pathogens of the 100 identified were resistant to this antimicrobial therapy. We believe that there should always be a macrolide, erythromycin or the latest ones such as azythromycin, in the treatment of CAP, owing to their efficiency, ease of use and lower cost.

Primary mediastinal seminoma

We describe three cases of primary mediastinal seminoma, a rare neoplasm histologically similar to the testicular form, which mainly affects men between 30-60 yrs of age. Case No. 1--a 45 year old patient was treated with a combination of radiotherapy and chemotherapy. Twenty six months after the diagnosis, the patient shows a limited residual lesion, a good general health status and was asymptomatic. Case No. 2--a 56 year old patient was admitted for suspected epithelial lung cancer, with subsequent histological diagnosis of seminoma on surgical sample. The exeresis of the lesion was followed by radiotherapy and chemotherapy, the latter interrupted owing to the onset of thrombotic complications resulting in the patient's death. Case No. 3--a 35 year old patient was subjected to diagnostic and therapeutic thoracotomy, with diagnosis of primary mediastinal seminoma. The surgical therapy was followed by a cycle of radiotherapy. Five years later, the general health of the patient is good and he is still asymptomatic. In the discussion we consider the embryogenesis, clinical picture, radiological and anatomicopathological aspects, typical biomarkers of cancer, diagnostic procedures and therapeutic protocols currently followed.

[The importance of measuring plasma carcinoembryonic antigen in small-cell anaplastic carcinoma]

The clinical value of the serum biomarker carcinoembryonic antigen (CEA) was evaluated prospectively in 118 patients with small cell lung cancer (SCLC) entered chemotherapy protocol between 1986 and 1992. Five quantitative categories were determined: less than 2.5 ng/ml and 2.6-5.0 ng/ml (the standard normal), 5.1-20.0 ng/ml, 20.1-100 ng/ml and greater than 100 ng/ml. 70% of patients had levels less than 5 ng/ml and only 19% had levels greater than 20 ng/ml. There was no clearcut relationship of plasma CEA level to stage of disease, in which 61% of patients with extensive disease (59 patients) had levels less than 5 ng/ml and 22% of patients with limited disease (59 patients) had levels greater than 5 ng/ml. There was a modest relationship of CEA levels to presence of metastases, in that 50% of patients with metastases had levels greater than 20 ng/ml. The average survival for the pathologic and normal category was almost similar, ranging from 13.27 to 16.81 months. The correlation between disease extent and survival was more sensitive for lactate dehydrogenase (LDH) than for CEA. So CEA as a tumor marker for SCLC must be applied in conjunction with other biomarkers, particularly LDH and neuron specific enolase (NSE) and is meaningful in only a small proportion of patients.

Adenosine, a cytoprotective autocoid: effects of adenosine on neutrophil plasma membrane viscosity and chemoattractant receptor display

At inflammatory sites neutrophils are stimulated to produce a variety of toxic agents, yet rarely harm the endothelium across which they migrate. We have recently found that endothelium releases adenosine which, acting via receptors on the surface of human neutrophils, inhibits generation of toxic metabolites by stimulated neutrophils but, paradoxically, promotes chemotaxis. Agents which diminish plasma membrane viscosity affect neutrophil function similarly, possibly by modulating chemoattractant receptor number or affinity. We therefore determined whether adenosine receptor agonists modulate neutrophil function by decreasing membrane viscosity and/or changing the affinity of chemoattractant (N-fMet-Leu-Phe, FMLP) receptors. Surprisingly, 5'-(N-ethylcarboxamido)adenosine (NECA, 10 microM), the most potent agonist at neutrophil adenosine receptors, increased plasma membrane viscosity, as measured by fluorescence anisotropy of the plasma membrane specific probe 1-(4-trimethylaminophenyl)-6-diphenyl-1,3,5-hexatriene (TMA-DPH), in unstimulated neutrophils from a mean microviscosity of 1.67 +/- 0.02 (S.E.) to 1.80 +/- 0.02 (p less than 0.001) while inosine (10 microM), a poor adenosine receptor agonist, had no effect (1.73 +/- 0.04, p = n.s. vs. control, p less than 0.01 vs. NECA). Adenosine receptor agonists increased plasma membrane viscosity in neutrophils with the same order of potency previously seen for inhibition of superoxide anion generation and enhancement of chemotaxis (NECA greater than adenosine = N6-phenylisopropyladenosine). The adenosine receptor antagonist 8-(p-sulfophenyl)theophylline reversed the effect of NECA on plasma membrane viscosity. Unlike other agents which modulate plasma membrane viscosity, NECA (10 microM) did not significantly change the number or affinity of [3H]FMLP binding sites on neutrophils. In contrast to the hypothesis of Yuli et al. these results indicate that occupancy of adenosine receptors on neutrophils increases plasma membrane viscosity without affecting chemoattractant receptor display.