Men.Phys - Reducing sedentary behavior and increasing physical activity in people with severe mental illness in an acute psychia- tric ward: a research protocol for a randomized controlled trial

Background

People with Severe Mental Illness (SMI) (schizophrenia, bipolar disorder, major depressive disorder, and personality disorders) experience a considerable risk of premature mortality because of cardiovascular disease, smoking, metabolic syndrome, etc. Recent research has demonstrated that this population spends almost 13 h per day being sedentary. Sedentary behavior (SB) is an independent risk factor for cardiovascular disease and mortality. Given the potential for physical activity (PA) to improve health and well-being in people with SMI, we developed a pilot randomized controlled trial (RCT) to evaluate a group intervention aimed at reducing SB and increasing PA of inpatients with SMI. Our primary aim is to assess the acceptability and feasibility of Men.Phys protocol, a new integrated treatment protocol for psychiatric inpatients. Secondary aims are to verify if the Men.Phys protocol decreased sedentary behavior and increased well-being, in terms of quality sleep, quality of life, and psychopathological symptoms and other measures.

Methods

Will be enrolled people with SMI consecutively admitted to the emergency psychiatric ward in Colleferro, near Rome. Participant's physical activity, health, psychiatric and psychological status will be assessed at baseline. Randomised participants will receive treatment as usual (TAU) or the Men.Phys intervention. Men.Phys involves a group activity conducted by a mental health practitioner, during which patients repeat exercises that showed through a monitor. The protocol provides that, during hospitalization, the patient follow at least 3 sessions consecutively. Lazio 1 ethics Committee approved this research protocol.

Results and Conclusions

To our knowledge, Men.Phys is the first RCT to investigate the impact of a group intervention targeting sedentary behavior in people with SMI during psychiatric hospitalization. If the intervention should be feasible and acceptable, further large-scale study can be developed and then implemented in routine care.

Porcine coronary arteries: immunohistochemical profile of TNF-alpha, IL-1beta, TGF-beta1 and ICAM-1

BACKGROUND

In our study we used immunohistochemical technique to demonstrate the presence of the cytokines tumour necrosis factor alpha (TNF-α), interleukin 1beta (IL-1β), transforming growth factor beta1 (TGF-β1) and intercellular adhesion molecule-1 (ICAM-1) in porcine coronaries even in physiological conditions.

MATERIALS AND METHODS

Inflammatory cytokines are polypeptide mediators which act as a communication signal between immune system cells and other types of cellsin different organs and tissues, both in human and pig coronary circulation.

RESULTS

Our results show that pro-inflammatory cytokines TNF-α, IL-1β, TGF-β1 and ICAM-1 are also present in the medium tunica of the coronary arteries under physiological conditions. These results may be compared with those found in coronary atherosclerosis, where the increase in TNF-α has a dramatic effect on the function of the left ventricle, and the high value of IL-1 correlates directly with the extent of myocardial necrosis. In our study we observe the damage and activation of endothelial cells; this induces endothelial dysfunction by accumulation and oxidation of low density lipoproteins (LDL). The formation of oxidized LDL could play a central role in the amplification of the inflammatory response causing an increased expression of pro-inflammatory cytokines which promotes leukocyte recruitment in the intimal layer. These leukocytes, after the adhesion to the endothelium, penetrate the intimate tunic.

CONCLUSIONS

Therefore inflammatory processes promote the onset and evolution of atheroma and the development of thrombotic complications.

Are 2020’s medical students still suffering from gender stereotypes? An Italian study

Background

Gender medicine is crucial to reduce health inequalities in Europe. Knowledge about medical students' attitudes and beliefs regarding sex and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender awareness and its predictors in Italian medical students.

Methods

During 2020, we performed a cross-sectional study among medical students from the University of Turin, Italy. We used the validated Nijmegen Gender Awareness Scale in Medicine (N-GAMS) to investigate gender sensitivity (GS) and gender role ideology towards patients (GRIP) or doctors (GRID). Multivariable logistic regression model was performed to explore potential predictors of gender awareness.

Results

Globally, 430 participants completed the survey (68.4% were females). The 62.5% of male students had a poor knowledge of gender medicine. GRID score significantly differs between males and females (1.64±0.68 vs 1.51±0.49; p = 0.028). Males had lower GS scores (coefB -0.96, p < 0.05), while students who had a better knowledge on gender medicine (coefB 0.14, p < 0.05) and those who have received good example from tutors (coefB 0.14, p < 0.05) were more gender-sensitive. Older age (coefB 0.04, p < 0.05), a better knowledge on gender medicine (coefB 0.12, p < 0.05) and having had a tutor sensitive to gender issues (coefB 0.13, p < 0.05) were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine (coefB 0.03, p < 0.05), male sex (coefB 0.12, p < 0.05) and older age (coefB 0.03, p < 0.05) were associated with more stereotypes towards doctors.

Conclusions

Gender stereotypes are still common. During university courses and practical training more attention must be paid to explain that stereotyped gender differences are not scientifically proven and they do not contribute to provide better care. Therefore, the implementation of gender specific teaching throughout elective courses should be seriously considered.

Key messages

Receiving more knowledge and more attention about gender medicine during university education was associated with higher gender stereotypes in our sample of medical students. Interventions in European university education are needed to make gender medicine education more effective in order to reduce gender stereotypes and contribute to better care.

Vaccine adhesion before and after Vaxzevria suspension in a Local Health Unit of Piedmont - Italy

Introduction

The Oxford-AstraZeneca vaccine Vaxzevria is a viral-vector vaccine developed to prevent COVID-19 infection. Two doses scored 81.3% efficacy against symptomatic infection and 100% against hospitalization. In Italy, Vaxzevria use started in February. After two deaths among the Army, Italian Medicines Agency withdrawn the vaccine batch involved. News about fatal thrombosis increased, together with population concern. On March 14th, the Piedmont Region suspended another batch following a new time-related death. The following day, several European states suspended Vaxzevria administration waiting for indication from an EMA meeting on March 18th. The aim of Authors was to study the effect of suspension on adhesion among general population.

Methods

Authors registered vaccine adhesion of vaccination centers offering Vaxzevria. To access vaccination, people was requested to express willingness through a website. Then, access was granted with a summoning SMS or e-mail. Vaxzevria target populations were members of law enforcement agencies and school personnel of any age. Data from February 25th to April 12th form a Local Healthcare Unit in Piedmont Region (Italy).

Results

Vaccine adhesion ranged from 95 to 100% from February 25th to March 12th (mean 97%). During March 13th it decreased to 73%, then 48% on March 14th, the day of local withdraw of all Vaxzevria doses in Piedmont Region. Activity restarted on March 19th with a 65% of adhesion, and a mean of 75% (69-81%) in the following days. From March 24th-31th adhesion recovered, with a mean 89%. April 1st-12th recorded a plateau: 81-100%, mean 91%. From March 13th a total of 1478 people out of 8339 (17.7%) did not receive their scheduled vaccination.

Conclusions

Both news and official statements had an impact on trust and vaccine adhesion among population and dramatically slowed the COVID-19 vaccine campaign, with a possible effect on infection spreading. Further data and analysis will be provided in the following months.

Key messages

Vaxzevria temporary suspension had an impact on vaccine adhesion. Vaccine adhesion took one month to go back to previous values.

Gender medicine: a cross-sectional survey on knowledge and curriculum among Italian medical students

Introduction

Gender and sex are important predictors of many attitudes and behaviours that have an impact on health and disease. Gender medicine is then a fundamental approach for better quality of care in Europe. Few information is available on Italian medical students and their knowledge about gender medicine. Our study aimed to investigate knowledge about gender medicine in a sample of Italian medical students in order to identify specific knowledge gaps and improve Medicine degree curricula.

Methods

In 2020, an online cross-sectional survey was conducted on 430 medical students of the University of Turin, Italy. Participants filled out a questionnaire consisting of 29 items concerning the areas of knowledge and attitudes regarding gender medicine. Multivariable logistic regression model was performed to explore potential predictors of knowledge among students.

Results

More than 60% of the students knew the correct definition of gender medicine and around 90% of them knew the difference between sex and gender. In total, 58.16% of female students had a good level of knowledge, significantly more than male students (37,5%; p < 0.001); female students also showed a higher mean score compared to male students (respectively 17.96±2.75 vs 16.59±3.20, p < 0.001). Using a multivariate linear regression model, with level of knowledge about gender medicine used as a continuous variable, we found that being female was the only potential predictor of high consideration of gender medicine in patient management.

Conclusions

The results indicate that students have a good knowledge and high regard for gender medicine. Female students seem more aware of the importance of gender medicine and areas of improvement can be identified. Future European physicians must consider gender medicine in order to encourage a patient-tailored approach and to reduce gender gap still existent in current practice.

Key messages

Gender medicine is a fundamental approach to improve quality of care and to reduce gender gap among European patients. Medical students should be more aware and trained about gender and sex differences during clinical practice in order to encourage a patient-tailored medicine.

Design, implementation and assessment of a drive-through flu mass-vaccination program in Italy

Problem

The SARS-CoV-2 pandemic has completely changed health systems around the world.

As part of a mass immunization campaign with COVID-19 vaccines, it was necessary to study new methods to vaccinate a large number of people in a short time and in complete safety.

Description of the problem

To ensure the requirements of speed, safety and low cost, we therefore designed an EBM model of drive-through flu-vaccination, built in the city of Rivalta di Torino (about 20,000 inhabitants), in Northern Italy, on two Saturdays in November 2020. The project was created by Public Health Residents with the collaboration of the Municipality, a team of Family Doctors and Civil Protection.

Results

We measured driving time for each vehicle from the check-in station to the parking zone designed for the 15min post-vaccination follow-up. We calculated the mean length of stay time (LOS) and the mean time per person based on the number of individual vaccinations given per vehicle. In two days, 1539 vaccines were administered. Flows were only timed on the first day (417 vehicles and 672 vaccines). The highest percentage of cars (47%) received only one vaccination per vehicle, followed by 2 (45.8%), 3 (6.2%), and 4 (1%) vaccines per vehicle. The optimal number of vaccinations per vehicle to maximize efficiency was 4: the average LOS per vaccination decreased from 2.54 minutes per person (1 vehicle=1 person) to 0.34 seconds per person (1 vehicle=4 people). The mean LOS time was 3.06min (SD1.11).

Lessons

This model appeared as a real possibility to start a rapid, effective, safe and low-cost mass-vaccination program in the Italian setting. It also seems to be appreciated by the population, not only in terms of novelty but also for the sense of security and speed of the process. For this reason, in April 2021, the same model was successfully applied in the same area for COVID-19 vaccination.

Key messages

The drive-through model appeared as a real possibility to start a rapid, effective, safe and low-cost mass-vaccination program in the Italian setting. The Pandemic has changed the needs and methods of carrying out common health practices: the drive-through model has proved to be a valuable resource for mass vaccination.

Empowering seizures awareness: knowledge, attitudes and fears of school staff trained in rescue drugs

Background

The administration of rescue medication at school concerns, in all Europe, students suffering from chronic pathologies for which it may be essential, on doctor's prescription, to take therapy during school hours. About 16% of the school's emergency calls are related to a seizure crisis. In this case, since the parents are absent, the first rescuer is necessarily the school staff, who should be properly trained because prolonged seizures can cause severe harm and even death.

Methods

Every year, the Local Health Unit “TO3”, in Northern Italy, provides training for school staff to administrate rescue medication at school. A questionnaire survey on knowledge, attitudes and fears towards seizures was conducted during the school year 2019/2020. The same questionnaire was administered to school staff trained for seizures at the end of the course, while the staff trained for other diseases such as diabetes, allergies and asthma completed it before the course.

Results

110 questionnaires have been completed. About 60% of the sample had been trained in seizure management at least once in their lifetime. The respondents had a mean age of 48.7±9.6 years and a mean job experience of 17.4±11.2 years. Most of them were females (83%). Median knowledge score (10 points max) in subjects with no seizures training was 6, while it was 8.5 in subjects with seizures training (p < 0.001). The self-reported level of confidence in their own skills to administer rescue medication was high in 10.4% of subjects not trained for seizures and in 63.8% of those trained (p < 0.001).

Conclusions

Results suggest that medical training for school staff boosts knowledge scores and levels of self-confidence relating to the administration of rescue medication. Moreover, after the training, the school staff changed attitude towards seizures, no longer considered as a problem, and became more aware, less fearful, and more inclined to act in case of need, making school a safer place for all students.

Key messages

School staff trained in the administration of rescue medication are fundamental to guarantee the right to education for students suffering from chronic pathologies such as seizures. Empowering seizures awareness in schools is very important to change the attitude of school staff no longer considering seizures as a problem, making school a safer place for all European students.

[Pathophysiology of aggressive behavior: evaluation and management of pathological aggression]

This work aims to define the aggression in all its forms, with notes on management and rapid tranquilization. The pathological aggression is described as a non-homogeneous phenomenon, it is variable in according to social, psychological and biological agents. The distinction of violence between affective aggression and predatory aggression can be functional to the prediction of outcome of any treatment. In general, a pattern of predatory violence tend to match with patients unresponsive and not compliant to treatment, a low probability to predict future violence and, therefore, a difficulty in managing risk. The affective aggressor, however, shows increased probability of treatment response, with more predictability of violent actions in reaction to situations perceived as threatening and, therefore, greater management of future violence risk. Those who act affective violence tend to show a wide range of emotional and cognitive problems, while those who act with predatory patterns show greater inclination to aggression and antisocial behavior. Aggression that occurs in psychiatry mostly appears to be affective, therefore susceptible to modulation through treatments.

Palmitoylethanolamide controls reactive gliosis and exerts neuroprotective functions in a rat model of Alzheimer's disease

Given the complex heterogeneity of pathological changes occurring in Alzheimer's disease (AD), any therapeutic effort absolutely requires a multi-targeted approach, because attempts addressing only a single event may result ineffective. Palmitoylethanolamide (PEA), a naturally occurring lipid amide between palmitic acid and ethanolamine, seems to be a compound able to fulfill the criteria of a multi-factorial therapeutic approach. Here, we describe the anti-inflammatory and neuroprotective activities of systemic administration of PEA in adult male rats given intrahippocampal injection of beta amyloid 1-42 (Aβ 1-42). Moreover, to investigate the molecular mechanisms responsible for the effects induced by PEA, we co-administered PEA with the GW6471, an antagonist of peroxisome proliferator-activated receptor-α (PPAR-α). We found that Aβ 1-42 infusion results in severe changes of biochemical markers related to reactive gliosis, amyloidogenesis, and tau protein hyperphosphorylation. Interestingly, PEA was able to restore the Aβ 1-42-induced alterations through PPAR-α involvement. In addition, results from the Morris water maze task highlighted a mild cognitive deficit during the reversal learning phase of the behavioral study. Similarly to the biochemical data, also mnestic deficits were reduced by PEA treatment. These data disclose novel findings about the therapeutic potential of PEA, and suggest novel strategies that hopefully could have the potential not just to alleviate the symptoms but also to modify disease progression.

Inflammatory Profile of Neurotrophins, IL-6, IL1-β, TNF-α, VEGF, ICAM-1 and TGF-β in the Human Waldeyer's Ring

The palatine tonsils, nasopharyngeal tonsil (adenoid) and lingual tonsil constitute the major part of Waldeyer's ring, with the tubal tonsils and lateral pharyngeal bands as less prominent components. The lymphoid tissue of Waldeyer's ring is located at the gateway of the respiratory and alimentary tract and belongs to the mucosa-associated lymphoid tissue (MALT). Mucosae-associated lymphoid tissues are richly innervated and the mucosae contain peptidergic nerve endings associated with different types of cells and macrophages. The lymphatic tissue is known to interact with the nervous system and several organs implicated in the host response to a wide range of stressors. This study focuses on the expression of some neurotrophins (NTs), their high- and low-affinity receptors in human adenoid tissues, lingual and palatine tonsils via immunohistochemical analysis, as well as on the expression of some inflammatory cytokines and other tissue growth factors. Light microscopy immunohistochemistry showed human samples to be generally positive for all the NTs investigated (NGF, BDNF, NT-3) and their receptors (TrKA, TrKB and TrKC) with some different expression levels. IL-6, IL1-b, TNF-α, VEGF, ICAM-1 and TGF-b were also investigated by immunohistochemistry. These results suggest the presence of a pattern of neurotrophic innervation in the human lymphatic tissues which may play a role in sustaining inflammatory conditions and in modulating a close interaction between the nervous system and the different immune cellular subtypes. Our data also corroborate previous studies, suggesting that neurotrophins and inflammatory cytokines may mediate functional signals in lymphoid aggregates. In this context, owing to their widespread expression in immune organs and immunocompetent cells, NTs and inflammatory cytokines are potential candidates for a prominent role in the regulation of immune and neuroimmune interactions.

Histochemical approaches to assess cell-to-cell transmission of misfolded proteins in neurodegenerative diseases

Formation, aggregation and transmission of abnormal proteins are common features in neurodegenerative disorders including Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, and Huntington's disease. The mechanisms underlying protein alterations in neurodegenerative diseases remain controversial. Novel findings highlighted altered protein clearing systems as common biochemical pathways which generate protein misfolding, which in turn causes protein aggregation and protein spreading. In fact, proteinaceous aggregates are prone to cell-to-cell propagation. This is reminiscent of what happens in prion disorders, where the prion protein misfolds thus forming aggregates which spread to neighbouring cells. For this reason, the term prionoids is currently used to emphasize how several misfolded proteins are transmitted in neurodegenerative diseases following this prion-like pattern. Histochemical techniques including the use of specific antibodies covering both light and electron microscopy offer a powerful tool to describe these phenomena and investigate specific molecular steps. These include: prion like protein alterations; glycation of prion-like altered proteins to form advanced glycation end-products (AGEs); mechanisms of extracellular secretion; interaction of AGEs with specific receptors placed on neighbouring cells (RAGEs). The present manuscript comments on these phenomena aimed to provide a consistent scenario of the available histochemical approaches to dissect each specific step.

Effects and Trimethyltin on Hippocampal Dopaminergic Markers and Cognitive Behaviour

The triorganotin compound trimethyltin (TMT) is a highly toxic molecule which has a great impact on human health. The aim of this study was to investigate the specific alteration of dopamine receptors and transporters in the hippocampus of TMT-treated rats. The TMT-treated group showed impaired spatial reference memory in a Morris water maze task compared to the control group, whereas memory consolidation tested 24 hours after the last training session was preserved. In the open field, TMT-treated rats showed a decrease in time spent in rearing episodes reflecting a lower interest to explore a novel environment. In the hippocampal area of the TMT-treated group, we observed a reduction in neuronal viability accompanied by a significant decrease in the expression of the dopamine receptors (D1 and D2), and dopamine transporters (DAT, VMAT1 and VMAT2). A less pronounced reduction was observed for D3 and D5 while D4 did not change. These data were confirmed by RT-PCR analysis. The present study on TMT-induced neurodegeneration highlights the link between hippocampal asset of dopamine receptors and transporters and the impaired performance of rats in a spatial reference memory task.

Thrombin and thrombin-derived peptides promote proliferation of cardiac progenitor cells in the form of cardiospheres without affecting their differentiation potential

Many studies demonstrated that human adult cardiac progenitor cells in the form of cardiospheres (CSps) could represent a powerful candidate for cardiac cell therapy. To achieve the clinical translation of this biotechnological product, the development of well-defined culture conditions is required to optimize their proliferation and differentiation. Thrombin, a serine protease acting through the protease-activated receptor 1 (PAR-1) signalling to modulate many cellular functions such as proliferation and differentiation in several cell types, is one of the factors included in the CSps medium. Therefore, the assessment of the effective dependence of the thrombin related cellular effects from PAR-signalling is strategic both for understanding the biological potential of these cells and for the GMP translation of the medium formulation, using synthesised analogs. In this study the effects of thrombin on human CSps and their potential relationship with the specific proteolytic activation of PAR-1 have been investigated in different culture conditions, including thrombin inhibitor hirudin and PAR-1 agonist/ antagonist peptides TFLLR and MUMB2. In this study we show that, in the presence of thrombin and TFLLR, CSps, in which PAR-1 expression was evidenced by immunofluorescence and western blot analysis, increase their proliferation activity (BrdU assay). Such increased proliferative rate was consistently associated with a higher phosphorylation level of the cell cycle inhibitor GSK3. Concerning the assessment of the potential effects of thrombin and its agonist on differentiation, both western blot and real-time PCR analysis for stemness, cardiac and vascular markers (such as cKit, cx43 and KDR) showed that CSps commitment was substantially unaffected, except for GATA4 mRNA, whose transcription was down-regulated in the presence of the natural protease, but not after treatment with TFLLR. In conclusion, activation of PAR-1-dependent signalling is important to support CSps proliferative potential, keeping unaltered or at best stable their differentiation properties. The availability of thrombin agonists, such as TFLLR, able to guarantee the required growth effect without affecting CSps lineage commitment, could represent a technological improvement for cost-effective, easy-to-handle and GMPtranslatable synthetic media.

White matter reduced streamline coherence in young men with autism and mental retardation

BACKGROUND AND PURPOSE

It has been proposed that white matter alterations might play a role in autistic disorders; however, published data are mainly limited to high-functioning autism. The goal of this study was to apply diffusion tensor imaging (DTI) and fiber tractography (FT) to study white matter in low-functioning autism and the relationship between white matter and cognitive impairment.

METHODS

Ten low-functioning males with autism (mean age: 19.7 +/- 2.83 years) and 10 age-matched healthy males (mean age: 19.9 +/- 2.64 years) underwent DTI-MRI scanning. fractional anisotropy (FA) maps were analyzed with whole brain voxel-wise and tract-of-interest statistics. Using FT algorithms, white matter tracts connecting the orbitofrontal cortex (OFC) with other brain regions were identified and compared between the two groups. FA mean values of the autistic group were correlated with intelligence quotient (IQ) scores.

RESULTS

Low-functioning autistic subjects showed a reduced tract volume and lower mean FA values in the left OFC network compared with controls. In the autistic group, lower FA values were associated with lower IQ scores.

CONCLUSIONS

We showed evidence of OFC white matter network abnormalities in low-functioning autistic individuals. Our results point to a relationship between the severity of the intellectual impairment and the extent of white matter alterations.

Methamphetamine induces ectopic expression of tyrosine hydroxylase and increases noradrenaline levels within the cerebellar cortex

Methamphetamine produces locomotor activation and typical stereotyped motor patterns, which are commonly related with increased catecholamine activity within the basal ganglia, including the dorsal and ventral striatum. Since the cerebellum is critical for movement control, and for learning of motor patterns, we hypothesized that cerebellar catecholamines might be a target of methamphetamine. To test this experimental hypothesis we injected methamphetamine into C57 Black mice at the doses of 5 mg/kg two or three times, 2 h apart. This dosing regimen is known to be toxic for striatal dopamine terminals. However, we found that in the cerebellum, methamphetamine increased the expression of the primary transcript of the tyrosine hydroxylase (TH) gene, followed by an increased expression of the TH protein. Increased TH was localized within Purkinje cells, where methamphetamine increased the number of TH-immunogold particles, and produced a change in the distribution of the enzyme by increasing the cytoplasmic percentage. Increased TH expression was accompanied by a slight increase in noradrenaline content. This effect was highly site-specific for the cortex of posterior vermal lobules, while only slight effects were detectable in the hemispheres. The present data indicate that the cerebellum does represent a target of methamphetamine, which produces specific and fine alterations of the catecholamine system involving synthesis, amount, and compartmentalization of TH as well as increased noradrenaline levels. This may be relevant for motor alterations induced by methamphetamine. In line with this, inherited cerebellar movement disorders in various animal species including humans are associated with increased TH immunoreactivity within intrinsic neurons of the same lobules of the cerebellar cortex.

Expression of neurotransmitters and neurotrophins in human adenoid tissue

Mucosae-associated lymphoid tissues are richly innervated and the mucosae contain peptidergic nerve endings associated with different types of cells and macrophages. The lymphatic tissue is known to interact with the nervous system and several organs, implicated in the host response to a wide range of stressors, and is also richly innervated. We focussed our attention on the immune organs with particular regard to the human adenoid lymphatic tissues in order to investigate the neuroimmune links and the possible existence of relationships among different neurotransmitters and lymphocytes, macrophages, epithelial cells and nerve fibers by testing the expression of certain neurotransmitters and neurotrophins (NTs) with their own receptors.

Effects of fluoxetine, indomethacine and placebo on 3 alpha, 5 alpha tetrahydroprogesterone (THP) plasma levels in uncomplicated alcohol withdrawal

OBJECTIVE

The purpose of this study was to investigate the effects of fluoxetine (F) and indomethacine (I), two drugs that regulate the synthesis of the GABAergic neurosteroid 3 alpha, 5 alpha tetrahydroprogesterone (allopregnanolone, THP) on THP plasma levels and on symptoms of anxiety and depression in alcoholics during ethanol withdrawal.

METHOD

Patients who met DSM-IV criteria for alcohol abuse were randomly assigned to treatment with F (40 mg/day) plus misoprostol (M) (500 mg/day) or I (100 mg/day) plus M or placebo (PL) plus M. Patients were rated with the Hamilton Anxiety (14-HAS) and Depression (17-HDS) scales on days 1, 5, 7, 15 and 28 of ethanol withdrawal and with a Visual Analogue Scale for Depression (VASD) and a Visual Analogue Scale for Anxiety (VASA) on days 1, 2, 4, 5, 7, 15 and 28 of withdrawal. On the same days a plasma sample was collected to measure the concentrations of THP by means of a very sensitive gas chromatographic mass spectrometric method.

RESULTS

During withdrawal at days 1, 2, 4 and 5, THP plasma values were lower and symptoms of anxiety and depression were significantly higher compared to the late withdrawal phase at days 15 and 28. In the F or I treatment, the depression and anxiety score, measured by VASD and VASA, decreased significantly at day 5-7 whereas THP plasma levels significantly increased compared to PL condition

CONCLUSIONS

Treatment of alcohol withdrawal either with F or I reduced the extent of anxiety and depression and normalised THP plasma levels that were decreased during withdrawal.

Identification of a short sequence highly divergent between beta-adrenergic-receptor kinases 1 and 2 that determines the affinity of binding to betagamma subunits of heterotrimeric guanine-nucleotide-binding regulatory proteins

A 28-residue peptide (peptide G), derived from the C-terminal (W643-S670) of the beta-adrenergic receptor kinase (betaARK), was previously identified as the critical domain for binding to the betagamma subunits of the heterotrimeric guanine-nucleotide-binding regulatory protein (G betagamma). We observed that the 18-amino-acid core of this domain is poorly conserved between betaARK1 and betaARK2 and so may provide the basis for differences in G betagamma-binding properties. Specific antibodies raised against 18-residue peptides derived from the divergent sequences (peptides P1 and P2 for betaARK1 and betaARK2, respectively) competitively inhibited G betagamma-activation of the related betaARK subtype, confirming the involvement of this region in binding to G betagamma. Peptides P1 and P2 inhibited G betagamma-stimulated activity of both betaARK1 and betaARK2, with P2 being significantly more potent than P1 (IC50 of 179+/-5 microM for P2 and >500 microM for P1). The 28-residue peptides G showed the same relative inhibitory activities (IC50 = 48+/-5 microM for G2 and 146+/-8 microM for G1). This relative order of potency G2 > G1 approximately P2 > P1 was confirmed in a direct G betagamma-binding assay. No binding selectivity for the beta1, beta2, beta3 and beta4 G beta subtypes was observed. The EC50 value for G betagamma-activation of betaARK1 was about double of that for betaARK2, indicating a higher affinity between G betagamma and betaARK2, which is the expected result based on the findings with the peptides. These findings show that the 18-residue peptides P represent the shortest sequence of betaARK that can bind to G betagamma and provide a demonstration of a functional difference between the G betagamma binding domains of betaARK1 and betaARK2.

Marked decrease of plasma neuroactive steroids during alcohol withdrawal

The neuroactive steroids allopregnanolone (ALLO) and allotet-rahydrodeoxycorticosterone (THDOC) are the most potent endogens positive modulators of gamma-aminobutyric acid (GABA) on GABAA receptors, a receptor system presumably responsible for some behavioral responses to alcohol withdrawal. In a group of nine alcoholic subjects, the levels of plasma ALLO and THDOC were markedly lower than those of control subjects during the early withdrawal phase (day 4 and 5), when anxiety and depression scores were higher. In contrast ALLO and THDOC plasma levels did not differ from those of control subjects during the late withdrawal phase when anxiety and depression scores were low. These results suggest that the decrease of neuroactive steroid biosynthesis may contribute to the withdrawal symptoms.

Protease inhibitors in mouse skeletal muscle: tissue-associated components of serum inhibitors and calpastatin

The proteinase inhibitor set in skeletal muscle is poorly characterized at present. This study was aimed to investigate in mouse skeletal muscle 1) the tissue-associated counterpart, if any, of serum protease inhibitors (which may also play antiproteolytic functions in tissues) and 2) calpastatin, a tissue inhibitor of calcium-activated neutral proteases (calpains). Triton-extracts were prepared from muscle homogenates of mice, which had been perfused extensively with phosphate buffered saline (PBS) (under deep anesthesia) to remove blood inhibitors. Among various inhibitors tested, the following muscle-associated inhibitors were identified by western-blotting: alpha-2-macroglobulin (185, 165, 35 kDa), alpha-1-antitrypsin (52 kDa), inter-alpha-trypsin inhibitor (220, 180 kDa) and calpastatin (70 kDa). Combined light microscope and confocal immunohistochemical experiments revealed that, in all muscles examined (soleus, plantaris, extensor digitorum longus) the above specific immunoreactivities were localized outside the muscle fibers (in periendomysium, blood vessel wall) as well as within them. Inter-alpha-trypsin inhibitor, however, completely lacked the intracellular localization. This wide distribution of proteinase inhibitors suggests that numerous muscular structures may be normally protected from unwanted proteolysis, thus providing an essential background for further studies on pathological models with altered proteolysis (m. dystrophy, denervation atrophy, etc.).

[Immunochemical and immunohistochemical study of calpastatin, an endogenous calpain inhibitor, in the masseter muscle of the rabbit]

The calpains-calpastatin system (calcium-activated neutral proteases and endogenous inhibitor) seems to be, in the skeletal muscle, a fine enzymatic system of myofibrillar turnover regulation, in normal as well as pathological conditions (for ex., dystrophic muscle). The purpose of the research is to establish in qualitative and quantitative terms whether the level of calpastatin can evidence differences between a muscle in normal activity conditions and one having dysfunctional alterations experimentally induced. So the masseter muscle of rabbit in normal conditions and with experimentally modified occlusal plane has been used. Our results confirm the presence of the 68 KDa calpastatin in the masseter muscle. The presence of the inhibitor in the same subcellular structures in which the calpains have been detected (myofibrillars, sarcolemma, endomysial connective) has been confirmed. Finally, variations in calpastatin amount in the muscle of animals experimentally treated with respect to the controls have been found. Thus, calpastatin seems to act as a marker of muscle dysfunctions connected to occlusal plane alteration and to loss of vertical dimention.

Immunohistochemical localization of serine-protease inhibitors in the human placenta

Proteases and their inhibitors play a pivotal role in developmental and differentiative processes. In the present report we investigated the immunohistochemical localization of alpha 1-antitrypsin, alpha 1-antichymotrypsin and inter-alpha-trypsin inhibitor in first trimester as well as in term human placentas. For this purpose polyclonal antibodies against these serine-protease inhibitors were used. All inhibitors were expressed in the villous syncytiotrophoblast of first and last trimester placentas. Placental fibrinoid was positively stained for alpha 1-antitrypsin and inter-alpha-trypsin inhibitor throughout gestation. alpha 1-Antitrypsin and alpha 1-antichymotrypsin showed a strong immunostaining in the Hofbauer cells (first trimester and full term placentas). Extravillous cytotrophoblast was negative for the three protease inhibitors throughout gestation. The presence of the three inhibitors in the syncytiotrophoblast suggests a role in coagulative, invasive and immunomodulatory processes. Fibrinoid, staining for alpha 1-antitrypsin and inter-alpha-trypsin inhibitor, could also have an important immunoprotective function. The presence of protease inhibitors in the Hofbauer cells suggests an involvement of these cells in villous remodelling and differentiative processes.

[The radiology of cerebral and paranasal sinus fungal lesions]

Pulmonary fungal infections have been increasingly reported in the patients with hematologic malignancies treated with aggressive chemotherapy and therefore presenting chemotherapy-induced leukopenia. The diagnosis of fungal infections in these severely immunocompromised hosts is of great importance, enabling the administration of an antifungal treatment to prevent potentially fatal fungal dissemination. This retrospective study was carried out to assess the most valuable conventional radiologic and CT features in the diagnosis of sinusal and cerebral mycosis infections. The authors reviewed their personal series of 71 patients with malignant hematologic diseases who developed a fungal lesion: twenty-eight cases were selected, 10 of them with an autoptic diagnosis of cerebral fungal lesions and 18 with a bioptic diagnosis of paranasal fungal lesions. In 10 patients with encephalic lesions, CT enabled four main types of tomodensitometric alterations with fungine etiology to be singled out--i.e., ischemic lesions, brain abscesses, granulomatoses and meningitis with possible brain parenchyma involvement. In 18 patients with fungal sinusitis, radiography and CT showed three main types of alterations: sinus opacities, pseudocystic images within the sinus and bone erosions. We conclude that in sinusal and cerebral fungal lesions no "specific criteria" can be established for the radiologic differential diagnosis between different fungine species and between fungine lesions with different etiologic agents.

Immunogold ultrastructural localization of calpastatin, the calpain inhibitor, in rabbit skeletal muscle

The ultrastructural localization of calpastatin, the endogenous inhibitor of the neutral calcium-dependent proteases (calpains), was investigated in rabbit skeletal muscle fibers using a polyclonal antibody against the 34 kDa form of the inhibitor isolated from rabbit. Quantitative studies by pre- and postembedding immunogold techniques revealed that the distribution pattern of the specific immunoreactivity included: 1) the sarcolemma with the adjacent cytoplasm (about 1 micron wide); 2) the myofibrils; 3) the mitochondria and 4) the nuclei (condensed as well as extended chromatin). Other cell substructures, such as lysosomes and the intermyofibrillar cytoplasm, were substantially devoid of immunoreactivity. Furthermore, in accordance to previous light microscope immunohistochemical experiments, an extracellular (endomysial) localization of specific immunoreactivity was confirmed. These results favour the view, which is also supported by a series of biochemical evidences, that calpastatin in rabbit skeletal muscle is present in cell structures also containing calpains and/or their putative substrates. The above multiple patterns of distribution also suggest that the muscular calpain-calpastatin system in skeletal muscle fibers may play different physiological roles in the various subcellular compartments.

Inter-alpha-trypsin inhibitor-related immunoreactivity in human tissues and body fluids

The distribution of inter-alpha-trypsin inhibitor (ITI) and related inhibitors was investigated in normal human tissues and body fluids by using an enzyme-linked immunosorbent assay (ELISA) and a streptavidin-biotin-peroxidase immunohistochemical technique. ITI-related immunoreactivity was localized in different cell types of various organs, such as liver, kidney, testis, gross intestine, cutis and brain. Specific immunoreactivity was also detected in serum, urine and bronchial mucus. This widespread, but not ubiquitous pattern of localization suggests that, in addition to the well known plasmatic role, ITI and/or ITI-related inhibitors may play a number of different physiological roles in various human tissues.

Calpain inhibitor in rabbit skeletal muscle: an immunochemical and histochemical study

Calpastatin, the endogenous inhibitor of calcium-activated neutral proteases (calpains; EC 3.4.22.17), was studied in the rabbit vastus lateralis muscle by means of immunochemical and immunohistochemical techniques. Immunoaffinity chromatography using an antibody raised against the 34-kDa monomer of the 68-kDa dimeric inhibitor allowed us to isolate three main proteins (130-, 100- and 80-kDa). These proteins strongly inhibited calpain activity in muscle homogenate (I50 at about 50 micrograms/ml). Immunohistochemical experiments showed that calpastatin-related immunoreactivity was present in all fibre types (oxidative, glycolytic, oxidative-glycolytic) at both surface and cytoplasmic level. However, a few (20%) of the slow-twitch, oxidative fibres (5% of the total fibres), did not contain the cytoplasmic inhibitor. Specific immunoreactivity for calpastatin was also associated with the interstitial connective tissue. These results suggest that (i) calpastatin in skeletal muscle, as in other tissues, is present as a mixture of proteins of various molecular weights and (ii) the inhibitor may act not only in the cytoplasm but also at the surface or extracellular level.