SLC19A1 Genetic Variation Leads to Altered Thiamine Diphosphate Transport: Implications for the Risk of Developing Wernicke-Korsakoff's Syndrome

AIMS

Wernicke-Korsakoff syndrome (WKS) is commonly associated with chronic alcohol misuse, a condition known to have multiple detrimental effects on thiamine metabolism. This study was conducted to identify genetic variants that may contribute to the development of WKS in individuals with alcohol dependence syndrome through alteration of thiamine transport into cells.

METHODS

Exome sequencing data from a panel of genes related to alcohol metabolism and thiamine pathways were analysed in a discovery cohort of 29 individuals with WKS to identify possible genetic risk variants associated with its development. Variant frequencies in this discovery cohort were compared with European frequencies in the Genome Aggregation Database browser, and those present at significantly higher frequencies were genotyped in an additional cohort of 87 alcohol-dependent cases with WKS and 197 alcohol-dependent cognitively intact controls.

RESULTS

Thirty non-synonymous variants were identified in the discovery cohort and, after filtering, 23 were taken forward and genotyped in the case-control cohort. Of these SLC19A1:rs1051266:G was nominally associated with WKS. SLC19A1 encodes the reduced folate carrier, a major transporter for physiological folate in plasma; rs1051266 is reported to impact folate transport. Thiamine pyrophosphate (TPP) efflux was significantly decreased in HEK293 cells, stably transfected with rs1051266:G, under thiamine deficient conditions when compared with the efflux from cells transfected with rs1051266:A (P = 5.7 × 10-11).

CONCLUSION

This study provides evidence for the role of genetic variation in the SLC19A1 gene, which may contribute to the development of WKS in vivo through modulation of TPP transport in cells.

Impact of coronary anatomy and residual syntax score on arrhythmic events in patients with ischemic cardiomyopathy

Funding Acknowledgements

Type of funding sources: None.

Background

ICD implantation is a cornerstone for primary prevention in patients with ischemic cardiomyopathy and impaired left ventricular function; reduced ejection fraction alone, however, doesn’t seem enough to discriminate which patients will really experience arrhythmic events in the follow up.

Purpose

We hypothesized that coronary anatomy and the extent of residual coronary lesions, measured with syntax score, could be a better predictor of the outcome in this setting.

Materials and method

Data of all patients implanted with single or dual chamber ICD in primary prevention for ischemic cardiomyopathy from 2011 to 2020 were retrospectively collected, together with follow up data obtained from clinical visits and ICD remote monitoring. Residual syntax score (RSS) was calculated for each patient, taking into consideration the last coronary angiography performed before ICD implantation.

Results

110 patients were included in our registry. 90.1% were male, mean age was 66±7 years. 23.6% ICD were dual chamber devices. 96 (87.2%), 8 (7.3%) and 6 (5.5%) patients presented respectively with low (0-22), intermediate (23-32) or high (≥33) RSS. After a mean follow up of 4.4±2.9 years, 31 patients (28.2%) died; 20 patients (18.2%) and 27 patients (24.5%) received any appropriate ICD therapy, either shock or ATP. 12 patients (10.9%) experienced inappropriate shock. The composite outcome of death or any appropriate therapy (MACE) was observed in 47 patients (42.7%); left main or left descending artery stenosis were predictors of MACE (p = 0.026 and p = 0.040, respectively). Intermediate or high RSS was the only predictor of appropriate shock (p = 0.046).

Conclusions

Coronary anatomy and residual coronary stenosis quantified with syntax score are promising predictors of arrhytmic events during the follow up in patients with ischaemic cardiomyopathy and ICD implanted in primary prevention.

P71 LEFT MAIN ANGIOPLASTY: TWENTY YEARS OF EXPERIENCE OF A HIGH–VOLUME SINGLE CENTRE WITH ANGIOGRAPHIC FOLLOW–UP

Long term result of left main angioplasty nowadays is still debated. The retrospective analysis of our reporting software detected from 11/2000 to 11/2021 a total of 956 patients that underwent percutaneous transcatheter coronary angioplasty (PTCA) on unprotected left main with de–novo lesions. The average age of our sample was found to be 72 years old (+–10), mainly male (76,4%). The prevalence of hypertension was 74,6%, of diabetes was 26,2%, of dyslipidaemia was 51,7%, of smoke was 49,8%. The indication for PTCA was ACS in 63,8% of patients (610), in particular STEMI were the 19,5% (186) of patients, NSTEMI were the 29,4% (281) and unstable angina were the 15% (143). Of these ACS in 29 patient the presentation was with cardiac arrest. Patient with CCS were the 36,2% (346). Intubation was necessary in 36 patients. Intra–aortic balloon pump was used in 341 patients (35,7%), in 90,9% of cases before the beginning of the procedure. Radial (45,1%) and femoral access (54,9%) were equally used. Among 773 bifurcations (the 80% of patients), a single stent technique was used in the 66,5% of cases (provisional). Considering the two stent techniques, the Crush was used in 12,7% of cases, the Culottes in 11,1%, the TAP in 6,7%, and the SKS in the 3%. Final kissing balloon was achieved in the 80,2% of bifurcations. Intracoronary imaging was used in the 48,4% of cases (463 patients), mainly IVUS (457). In our centre, as experimental protocol, an angiographic follow–up at 1 year is performed in most of patients that undergo angioplasty on left main. Overall, an angiographic follow–up is available for 607 patients (the 63,5% of patients) with an average lenth of 546 days. The indication for the new angiography was STEMI in 1,9% of patients, NSTEMI in 4,1%, unstable angina in 2,4%, stable angina in 8,6%, and only protocol in the 46,5%. Re–stenosis with redo of angioplasty on left main happened in 89 patients (14,7%), but of these only in 50 patients (56%) was clinically driven. Stent thrombosis was in all cases very–late (average 1609 days) and happened only in 7 patients (1,2%). A new PTCA in non–left main segments was performed in 153 cases (25,2%) and was clinically driven only in 50,4% of patients. Angiographic follow–up of complex PTCA such as those on unprotected left main could, in addition to potentially preventing adverse events, also provide interesting and real–world data about the effectiveness of the procedures and of their various technical aspects.

C35 SUCCESSFUL PERCUTANEOUS TREATMENT OF A GIANT CORONARY ANEURYSM IN THE EMERGENCY SETTING

In 2008, a 60–year–old man with an anterior STEMI and cardiogenic shock underwent coronary angiography: a thrombotic occlusion in the mid–LAD, distal to a coronary aneurysm, was successfully treated with DES. (Fig. A). In 2020, the patient was readmitted with NSTE–ACS and cardiogenic shock. The coronary angiography showed severe stenosis after the proximal–LAD aneurysm and occlusion of the previously implanted stent (Fig. B, Panel B1 and B3). A very slow distal coronary flow was provided by a huge epicardial collateral branch emerging from a second giant coronary aneurysm; furthermore, a severe stenosis in the proximal–LCX was present (Fig. B. Panel B1,2). The patient was judged inoperable by the cardiac surgeon. After IABP positioning, a DES was implanted in the LCX. The LAD was then approached. TIMI 3 flow was achieved after a challenging procedure requiring both coronary and peripheral interventional tools: 3 DES (yellow dotted–lines), 8 coronary and 1 peripheral covered stents (green solid–lines) and 6 coils were used to treat the stenosis and exclude the coronary aneurysms. (Fig. B, Panel B3,4). Both DAPT and oral anticoagulation were prescribed at discharge. A 4–month coronary angiography confirmed the good procedural result. (Fig. C). This case shows the unexpected enlargement of a coronary aneurysm through the years and the presence of a new uncommon epicardial communication, necessary to overcome a chronic coronary occlusion. It highlights the importance of knowing different interventional techniques and using non–conventional tools to approach complex coronary anatomies, such as aneurysmatic disease, whose treatment is often challenging, especially in complicated clinical scenarios.

C30 IMPACT OF CORONARY ANATOMY AND RESIDUAL SYNTAX SCORE ON ARRHYTHMIC EVENTS IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY

Background

ICD implantation is a cornerstone for primary prevention in patients with ischemic cardiomyopathy and impaired left ventricular function; reduced ejection fraction alone, however, doesn’t seem enough to discriminate which patients will really experience arrhythmic events in the follow up. We hypothesized that coronary anatomy and the extent of residual coronary lesions, measured with syntax score, could be a better predictor of the outcome in this setting.

Materials and Methods

Data of all patients implanted with single or dual chamber ICD in primary prevention for ischemic cardiomyopathy from 2011 to 2020 were retrospectively collected, together with follow up data obtained from clinical visits and ICD remote monitoring. Residual syntax score (RSS) was calculated for each patient, taking into consideration the last coronary angiography performed before ICD implantation.

Results

110 patients were included in our registry. 90.1% were male, mean age was 66±7 years. 23.6% ICD were dual chamber devices. 96 (87.2%), 8 (7.3%) and 6 (5.5%) presented respectively with low (0–22), intermediate (23–32) or high (≥33) RSS. After a mean follow up of 4.4±2.9 years, 31 patients (28.2%) died; 20 patients (18.2%) and 27 patients (24.5%) received any appropriate ICD therapy, either shock or ATP. 12 patients (10.9%) experienced inappropriate shock. The composite outcome of death or any appropriate therapy (MACE) was observed in 47 patients (42.7%); left main or left descending artery stenosis were predictors of MACE (p = 0.026 and p = 0.040 respectively). Intermediate or high RSS was the only predictor of appropriate shock (p = 0.046).

Conclusions

Coronary anatomy and residual coronary stenosis quantified with syntax score are promising predictors of arrhythmic events during the follow up in patients with ischaemic cardiomyopathy and ICD implanted in primary prevention.

P67 MAGMARIS FRACTURE AND COLLAPSE DURING PCI: ACUTE TREATMENT AND FOLLOW–UP

Resorbable Magnesium Scaffold (RMS) Magmaris represents an attractive alternative to permanent metal stenting in young patients undergoing PCI. Despite the promising long–term results, especially in terms of scaffold thrombosis, no data on acute RMS deployment failure and subsequent treatment are available. A 44–year–old gentleman with history of effort angina was admitted to our Department to perform coronary angiography. The exam showed an intermediate stenosis in the mid–tract of Left Anterior Descending (LAD, Figure 1, Panel A1), functionally significant (Instantaneous wave–free ratio 0.85). After Optical Coherence Tomography (OCT) evaluation (Panel A2), a wire was placed in Second Diagonal Branch (DG2) and predilation with a NC 3.5mm balloon on mid–tract of LAD was performed, followed by 3.5x25mm Magmaris implantation. Multiple runs performed after removing the jailed guidewire on Dg2, showed a remarkable angiographic result (Panel B1). However, OCT showed struts fracture near the distal RMS segment resulting in scaffold collapse as confirmed by 3D–reconstruction (Panel B2, B3). Therefore, scaffold dilatation with NC 3.5mm balloon was performed, followed by Magmaris 3.5x20mm intra–scaffold implantation. Panel C1 and C2 showed good angiographic and OCT results after postdilatation with NC 3.5 and 4.0mm balloon in the distal and proximal part, respectively. A planned one–year angiography (Panel D1) revealed a small aneurismatic enlargement in the previous overlapped segment, while no residual struts were visible at OCT. (Panel D2) To our knowledge we reported the first case of Magmaris acute fracture (probably due to a forced removal of the Dg2 jailed guidewire) treated with a second intra–scaffold RMS. The present case should emphasize the importance of intracoronary imaging guidance while more data are needed to clarify the optimal treatment of acute RMS implantation failure.

Disease-Modifying Drugs and Breastfeeding in Multiple Sclerosis: A Narrative Literature Review

Pregnancy-related issues in women with multiple sclerosis (MS) have been receiving increasing attention, with particular interest for the use of disease-modifying therapies (DMTs) before conception, during pregnancy, and postpartum, including breastfeeding. The risk of relapse is higher in the early postpartum period, especially in cases of significant disease activity prior to pregnancy, and thus treatment resumption and/or switching strategies might be necessary. Moreover, breastfeeding provides unmatched health benefits for babies and mothers, and is recommended as the best source of nutrition for infants. Furthermore, a protective role of breastfeeding on MS disease course has not been fully demonstrated and it remains debatable. At the same time, a source of concern is the potential transfer of DMTs into breastmilk and the resulting infant exposure. The use of most DMTs is unlicensed during breastfeeding mainly due to the limited data available on the excretion in human milk and on the effects on infants' exposure. Consequently, women have to face the difficult challenge of choosing between breastfeeding and DMT resumption. The present narrative review summarizes and discusses the available evidence on the safety of DMTs during breastfeeding and the relative approved labels. At the time of diagnosis of MS, specific counseling should be offered to women of childbearing age, making them aware of the possible therapeutic options and their impact on pregnancy and breastfeeding. Women can be encouraged to breastfeed, if clinically feasible, following a review of their medications and clinical status, with a personalized approach.

Ticagrelor or clopidogrel after acute coronary syndrome in the elderly: a propensity score matching analysis from 16 653 patients included in two large multinational registries

Background

Higher risk of bleeding with ticagrelor over clopidogrel in elderly patients with acute coronary syndrome (ACS) has been suggested.

Purpose

We assessed the incidence of major bleeding (MB), reinfarction (REAMI), and all-cause death in elderly patients to evaluate the safety and efficacy of ticagrelor versus clopidogrel in a population at high risk of bleeding and ischemia treated with percutaneous coronary intervention (PCI).

Methods

RENAMI and BleeMACS, real-world registries of patients with ACS who underwent PCI and received dual antiplatelet therapy, were merged. The pooled cohort was divided into two groups, clopidogrel versus ticagrelor and propensity score matching (PSM) analysis performed. Statistical analysis considered two age groups (<75 versus ≥75 years).

Endpoints were BARC 3–5 MB, REAMI and all-cause death at 1 year. Independent risk factors of MB were identified.

Results

The study included 16,653 patients (13,153 <75 and 3,500 ≥75 years). Ticagrelor was underused in elderly patients (16.3% versus 20.8%, P<0.001). Using PSM, two treatment groups of 1,566 patients were included in the final analysis. Ticagrelor appeared to prevent REAMI (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.2–0.6; P<0.001) and all-cause death (HR, 0.60; 95% CI, 0.4–0.9; P=0.026) irrespective of age. In patients ≥75 years, ticagrelor increased the incidence of MB compared with clopidogrel (HR, 1.49; 95% CI, 0.70–3.0; P=0.257) without statistical significance; ticagrelor was found to significantly reduce all-cause death (HR, 0.32; 95% CI, 0.1–0.8; P=0.012) and REAMI (HR, 0.25; 95% CI, 0.1–1.1, P=0.072) without statistical significance. Multiple Cox regression revealed that age (HR, 1.03; 95% CI, 1.02–1.05; P<0.001) was an independent risk factor for bleeding, whereas hemoglobin level was inversely proportional to bleeding (HR, 0.80; 95% CI, 0.72–0.88; P<0.001).

Conclusions

Ticagrelor did not significantly increase MB compared with clopidogrel in elderly patients hospitalized for ACS and treated with PCI, significantly improving 1-year survival. Further studies on elderly patients are required.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Astra Zeneca

P6409Ticagrelor and prasugrel versus clopidogrel in patients with acute coronary syndromes and chronic renal dysfunction: safety and efficacy

Introduction

Safety and efficacy of prasugrel and ticagrelor in real-life ACS (Acute Coronary Syndrome) with renal dysfunction remain to be established.

Methods

Consecutive patients from RENAMI and BLEEMACS were stratified according to renal function and estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2). Myocardial infarction (MI) and BARC major bleedings (MB; BARC type 3 or 5) were the primary end-point. Independent impact of clopidogrel, prasugrel and ticagrelor were evaluated with Cox multivariate analysis.

Results

19255 patients were enrolled (mean eGFR: 90±39 ml/min/1.73m2). Patients with eGFR<60 mL/min/1.73m2, constituted the 12.9% of the population (2490 pts). After a mean follow up of 13±5 months, the global incidence of re-AMI was of 5.8% and 2.9% in patients with and in those without eGFR<60 mL/min/1.73m2 (p<0.0001) respectively. MB occurred in 5.7% and 3% (p<0.0001). At Cox multivariate analysis, clopidogrel compared to prasugrel and ticagrelor was associated with increased risk of MI both in those with eGFR>60 mL/min/1.73m2 (HR=3.3: 2.4–4.4, p<0.0001) as well as in patients with eGFR<60 mL/min/1.73m2 (HR=10.04: 3.1–32.3, p<0.0001). In contrast, both prasugrel (HR=0.07: 0.01–0.54, p=0.01) and Ticagrelor (HR=0.36: 0.16–0.81, p=0.01) were associated with decreased risk of MI in the latters. DAPT with ticagrelor or prasugrel did not increased risk of MB in patients with eGFR<60 mL/min/1.73m2, while in patients with eGFR>60 mL/min/1.73m2, ticagrelor was associated to a slightly higher risk of MB (HR=1.43: 1.09–1.89, p=0.009).

Conclusion

In ACS patients with eGFR<60 mL/min/1.73m2, prasugrel and ticagrelor are associated with lower risk of recurrent MI without significant increase in the risk of MB.

Integrating ecosystem services into crop protection and pest management: Case study with the soil fumigant 1,3-dichloropropene and its use in tomato production in Italy

Ecosystems provide the conditions for producing food, regulating water, and providing wildlife habitats; these, among others, are known as ecosystem services (ESs). Food production is both economically and culturally important to southern European farmers, particularly in Italy where farmers grow flavorsome tomatoes with passion and pride. Growers rely on pesticides for crop protection, the potential environmental impact of which is often questioned by regulators and other stakeholders. The European regulatory system for the approval of pesticides includes a thorough evaluation of risks to the environment and is designed to be protective of ecosystems. The consideration of ESs in environmental decision making is a growing trend, and the present case study provides an example of how ESs evaluation could be used to enhance agricultural practices and regulatory policy for crop protection. By attacking plant roots, nematodes may affect the growth and yield of fruit and vegetable crops, and the income earned by farmers at harvest time. Available solutions include chemical treatments such as 1,3-dichloropropene (1,3-D), physical treatments (solarization), and biological treatments (biofumigation). In order to characterize the risks and benefits associated with the use of 1,3-D in crop protection, ESs and socioeconomic analyses were applied to its use in the control of nematodes in tomato cultivation in southern Italy. The present study confirmed the benefits of 1,3-D to tomato production in Italy, with significant positive effects on production yields and farm income when compared to limited and transient potential impacts on services such as soil function. It was confirmed that 1,3-D allows farm income to be maintained and secures tomato production in these regions for the future. Integr Environ Assess Manag 2016;12:801-810. © 2016 SETAC.

Genetic variants in or near ADH1B and ADH1C affect susceptibility to alcohol dependence in a British and Irish population

Certain single nucleotide polymorphisms (SNPs) in genes encoding alcohol dehydrogenase (ADH) enzymes confer a significant protective effect against alcohol dependence syndrome (ADS) in East Asian populations. Recently, attention has focused on the role of these SNPs in determining ADS risk in European populations. To further elucidate these associations, SNPs of interest in ADH1B, ADH1C and the ADH1B/1C intergenic region were genotyped in a British and Irish population (ADS cases n = 1076: controls n = 1027) to assess their relative contribution to ADS risk. A highly significant, protective association was observed between the minor allele of rs1229984 in ADH1B and ADS risk [allelic P = 8.4 × 10(-6) , odds ratio (OR) = 0.26, 95 percent confidence interval, 0.14, 0.49]. Significant associations were also observed between ADS risk and the ADH1B/1C intergenic variant, rs1789891 [allelic P = 7.2 × 10(-5) , OR = 1.4 (1.2, 1.6)] and three non-synonymous SNPs rs698, rs1693482 and rs283413 in ADH1C. However, these associations were not completely independent; thus, while the ADH1B rs1229984 minor allele association was independent of those of the intergenic variant rs1789891 and the three ADH1C variants, the three ADH1C variants were not individually independent. In conclusion, the rare ADH1B rs1229984 mutation provides significant protection against ADS in this British and Irish population; other variants in the ADH gene cluster also alter ADS risk, although the strong linkage disequilibrium between SNPs at this location precluded clear identification of the variant(s) driving the associations.

Appraising failure of surgical and percutaneous revascularization: long term outcomes from an observational registry

AIM

Many randomized trials have compared coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in terms of efficacy, but data comparing outcomes of patients in which these two techniques have failed are lacking.

METHODS

We included patients undergoing PCI at our center between July 2002 and December 2004. Subjects were distinguished in 2 groups: those with at least one occluded or stenotic saphenous vein graft (CABG failure), and those with at least one stent with angiographically documented restenosis (PCI failure). The primary endpoint was the long-term rate of major adverse clinical events.

RESULTS

Two hundred and thirthy four patients were included, with a medium follow up of 61±13 months; 134 were assigned to the CABG failure group, and 104 to the PCI failure group, sharing high rates of baseline risk factors. At long term rates of death were higher in post CABG group (22.1% vs. 9.9%; P=0.015, RR 2.24 C.I. 95% 1.14-4.40) while death rates in patients with diagnosis of diabetes mellitus (24.0% vs. 23.5%; P=0.969, RR 1.020 C.I. 95% 0.38-2.74) were not different

CONCLUSION

PCI can be safely offered to both these kinds of patients: as recently demonstrated post CABG outcomes seem to be more favorable in patients with diabetes mellitus.

Percutaneous drug-eluting stent implantation in diabetic patients: short and long term outcomes from an observational study

AIM

The introduction of drug-eluting stents (DES) has markedly improved mid-term results of percutaneous coronary intervention (PCI) in diabetics. However, it is unclear whether the risk-benefit balance of DES in diabetics is maintained also at long-term and in insulin-requiring patients. We thus aimed to appraise long-term outcomes of diabetic patients treated with PCI with DES, stratifying according to insulin therapy.

METHODS

We retrospectively collected baseline, procedural and outcome data from all patients undergoing PCI with DES from July 2002 to June 2004 at our center. We distinguished three groups: insulin-requiring diabetics, non-insulin-requiring diabetics and patients without diabetes. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e. the composite of death, myocardial infarction, or target vessel revascularization). We also considered stent thrombosis according to the Academic Research Consortium Definition.

RESULTS

We included a total of 1266 patients, with 3% of insulin-requiring diabetes, 22% with non-insulin-requiring diabetes, and 75% without diabetes. There were significant differences across groups in prevalence of male gender (respectively, 32.4%, 74.6% and 81%, P<0.001), and DES usage (54.1%, 34%, and 30.4%, P=0.007). Thirty-day MACE occurred with similar frequency in the three groups (8.1%, 7.3% and 6.3%, P=0.78), with death in 3%, 2%, and 1.4% (P=0.71) and myocardial infarction in 5.4%, 1.8% and 0.8% (P=0.02). After a median follow-up period of 58 months, MACE occurred in 59.5% of patients with insulin-requiring diabetes, in 50.6% of non-insulin-requiring diabetics and in 38.9% of non-diabetics (P<0.001). Death occurred in 24.3%, 17.5% and 8.5%, (P<0.001), myocardial infarction in 10.8%, 6.6%, and 5.1% (P=0.25), repeat revascularization in 46%, 31.6%, and 30% (P=0.11), and definite stent thrombosis in 0%, 1.1%, and 1.3% (P=0.78).

CONCLUSION

Our study confirms the high risk profile of diabetic patients, especially when ischemic disease it is known. In this setting, diabetic and comorbidities fix the price not only in term of need of further revascularization, but mainly in survival decrease. It can be concluded that not only revascularization but also ‑ and especially ‑ comorbidities treatment plays a determinant role reducing follow-up events. Further research on additional pharmacologic treatments or hybrid revascularization strategies may mitigate the burden of morbidity and mortality.

Fresh organic matter of municipal solid waste enhances phytoextraction of heavy metals from contaminated soil

In this study, the ability of the organic fraction of municipal solid wastes (OFMSW) to enhance heavy metal uptake of maize shoots compared with ethylenediamine disuccinic acid (EDDS) was tested on soil contaminated with heavy metals. Soils treated with OFMSW and EDDS significantly increased the concentration of heavy metals in maize shoots (increments of 302%, 66%, 184%, 169%, and 23% for Cr, Cu, Ni, Zn, and Pb with respect to the control and increments of 933%, 482%, 928%, 428%, and 5551% for soils treated with OFMSW and EDDS, respectively). In soil treated with OFMSW, metal uptake was favored because of the high presence of dissolved organic matter (DOM) (41.6x than soil control) that exhibited ligand properties because of the high presence of carboxylic acids. Because of the toxic effect of EDDS on maize plants, soil treated with OFMSW achieved the highest extraction of total heavy metals.

Efficacy of a new antidandruff thermophobic foam: a randomized, controlled, investigator-blinded trial vs. ketoconazole 2% scalp fluid

BACKGROUND

Ketoconazole (K), zinc pyrithione (ZP), and salicylic acid (SA) are compounds active in the treatment of dandruff. A thermophobic foam formulation containing K 1%, ZP 0.5%, and SA 2% is now available.

STUDY AIM

To compare the efficacy of thermo phobic foam with K 2% scalp fluid in the treatment of moderate to severe dandruff. Patients and methods In a randomized, prospective, parallel-group, investigator-blinded, 4-week treatment trial, a total of 54 patients (mean age 43 +/- 8 years) were enrolled. Foam (F group) (n = 37) or K 2% scalp fluid (SF group) (n = 17) was applied daily for 7 days and twice weekly for 3 weeks thereafter. Clinical assessment of the total dandruff severity score (TDSS) was performed at baseline, after 2 and 4 weeks. The TDSS was calculated using a four-grade quantitative score (0 = no dandruff; 3 = severe dandruff) dividing the scalp area into four zones and adding the single score for each area.

RESULTS

At baseline, TDSS was 7.1 +/- 2 and 5.1 +/- 1 in the F and SF groups, respectively. At the end of treatment period, beneficial effects were observed in both groups. The TDSS was reduced to 2.5 +/- 1 in the F group and to 3.7 +/- 1.2 in the SF group (mean difference in favor of F group: -1.2; 95% CI: -0.57 to -1.8) (P = 0.0003). A complete or nearly complete resolution of dandruff was observed in 24 out of 37 (64%: 95%CI: 48-77%) in the F group and in 7 out of 17 (41%: 95% CI: 21-64%) in the SF group (P = 0.06 between groups).

CONCLUSIONS

This new antidandruff thermophobic foam has shown to be more effective than ketoconazole 2% scalp fluid in the treatment of severe dandruff.

Biobased surfactant-like molecules from organic wastes: the effect of waste composition and composting process on surfactant properties and on the ability to solubilize Tetrachloroethene (PCE)

In this work, four surfactant-like humic acids (HAs) obtained from garden lignocellulose wastes and kitchen food wastes mixed with garden-lignocellulose wastes, both before and after composting, were tested for surfactant properties and the ability to solubilize tetrachloroethene (PCE). The waste-derived HAs showed good surfactant properties, lowering the water surface tension from 74 mN m(-1) to 45.4 +/- 4.4 mN m(-1), with a critical micelle concentration (CMC) of 1.54 +/- 1.68 g L(-1), which is lower than many synthetic ionic surfactants. CMC was affected by both waste origin and composting processes. The addition of food waste and composting reduced CMC by adding alkyl-C (measured by CP MAS 13C NMR) and N- and S-HA contents (amide molecules), so that a multistep regression was found [CMC = 24.6 - 0.189 alkyl C - 2.64 (N + S); R2 = 0.77, P < 0.10, n = 6]. The four HAs solubilized PCE at the rate of 0.18-0.47 g PCE/g aqueous biosurfactant. These results were much higher than those reported in the literature for a commercial HA (0.026 g/g), but they were in line with those measured in this work for nonionic surfactants such as Tween-80 (0.69 g/g) and Triton X-100 (1.08 g/g).

Evaluation of the efficacy and tolerability of oral terbinafine (Daskil) in patients with seborrhoeic dermatitis. A multicentre, randomized, investigator-blinded, placebo-controlled trial

BACKGROUND

Previous uncontrolled trials have suggested that oral terbinafine, an antimycotic allylamine compound, could be useful in the treatment of seborrhoeic dermatitis.

OBJECTIVES

To investigate in a placebo-controlled trial the clinical efficacy of oral terbinafine (Daskil(R), Mipharm, Milan, Italy) in patients with moderate to severe seborrhoeic dermatitis.

METHODS

Sixty outpatients (mean +/- SD age 37 +/- 11 years; 32 men and 28 women) with moderate to severe seborrhoeic dermatitis were enrolled in a multicentre, randomized, placebo-controlled, investigator-blinded, parallel-group, 12-week study. After a 2-week wash-out period, enrolled patients were randomized to treatment with oral terbinafine 250 mg daily (n = 30) or placebo (moisturizing ointment) (n = 30) applied twice daily for 4 weeks (weeks 0-4). Patients were followed up for an additional 8 weeks after completion of treatment and were clinically evaluated at weeks 0, 2, 4 and 12 by an investigator unaware of the patient's type of treatment. The primary end-point of the study was clinical evaluation of erythema, scaling and itching, each scored on a 0-3 scale. A global clinical score, representing the sum of each evaluated symptom, was also calculated.

RESULTS

Demographic and clinical data were equally balanced between the placebo and terbinafine groups. All enrolled patients concluded the study. At baseline, the mean +/- SD global clinical score was 7.4 +/- 1.3 in the placebo group and 7.7 +/- 1.0 in the terbinafine-treated group. At weeks 4 and 12 the mean +/- SD global clinical score in the placebo group was 5.9 +/- 1.7 and 6.3 +/- 1.2, respectively, which was not significantly different from baseline. As compared with baseline values and the placebo group, terbinafine treatment significantly (P < 0.0001, Tukey-Kramer test) reduced the mean +/- SD global clinical score (to 1.0 +/- 1.1 at week 4, and 1.2 +/- 1.4 at week 12), as well as the individual erythema, scaling and itching scores. No serious adverse events were recorded during the study in either group.

CONCLUSIONS

This is the first controlled trial that has shown oral terbinafine to be effective in the treatment of moderate to severe seborrhoeic dermatitis. Clinical improvement following 4 weeks treatment with terbinafine was maintained 8 weeks after completing treatment.

Marshall-Marchetti-Krantz urethropexy and Burch colposuspension for stress urinary incontinence in women with low pressure and hypermobility of the urethra: early results of a prospective randomized clinical trial

OBJECTIVE

The aim of the study was to compare the effects of Burch colposuspension and Marshall-Marchetti-Krantz urethropexy with videourethroscopic control in the correction of stress urinary incontinence in patients with low pressure and hypermobility of the urethra.

STUDY DESIGN

Thirty women were randomly assigned to undergo 1 of the 2 surgical procedures from November 1993 to May 1996 (15 Burch colposuspensions and 15 Marshall-Marchetti-Krantz urethropexies) and were evaluated subjectively and objectively for stress urinary incontinence at 2 and 12 months. Data obtained were analyzed with the Student t test, the Fisher exact test, and the Wilcoxon signed rank test.

RESULTS

At 1 year of follow-up 15 women in the Marshall-Marchetti-Krantz urethropexy group (100%) and 10 women in the Burch colposuspension group (66%) were subjectively considered cured (P =.02, 2-tailed Fisher exact test), and stress test results were negative in 14 women (93%) and 8 women (53%), respectively (P =.017, 2-tailed Fisher exact test). The resumption of spontaneous voiding was attained after 6.5 +/- 3.3 days in the Burch colposuspension group and in 20.5 +/- 13.4 days in the Marshall-Marchetti-Krantz urethropexy group (P <.001, 2-tailed Wilcoxon rank sum test).

CONCLUSION

The high cure rate and low associated morbidity mark the Marshall-Marchetti-Krantz procedure with videourethroscopic control as more effective than Burch colposuspension in repairing stress urinary incontinence associated with low pressure and hypermobility of the urethra.

Transabdominal repair of cystocele by wedge colpectomy during combined abdominal-vaginal surgery

The aim of the study was to evaluate the effectiveness of transabdominal wedge colpectomy as surgical treatment for cystocele. One hundred and sixty-three women with either first or second-degree cystocele (Beecham classification), rectocele and concomitant stress urinary incontinence or benign pelvic masses were submitted for a combined operation. Transabdominal repair of the cystocele was performed by wedge colpectomy employing two different absorbable sutures, Vicryl and PDS. The choice of suture was not random but depended on the period at which surgery was performed. Data obtained were analyzed with Student's t-test and Fisher's exact test. The cystocele cure rate was 90.2% (110 out of 122) at 3-year follow-up and was significantly associated with the preoperative degree, being 95.5% and 76.5% in first and in second degree, respectively (P = 0.003). At 1-year follow-up the cure rate was significantly associated with the type of the suture employed (P = 0.01). At 2-year follow-up rectocele cure rate was 97.2% and vaginal vault prolapse appeared in 3.5% of cases. Stress urinary incontinence relapsed in 10% of patients after Burch colposuspension. After the operation 94.1% of the women declared normal coitus. In the present series wedge colpectomy was found to be effective in repairing first-degree cystocele, whereas a high incidence of relapse was observed when second-degree cystocele was present preoperatively. The suture material employed influenced the cure rate.

Marshall-Marchetti-Krantz procedure and Burch colposuspension in the surgical treatment of female urinary incontinence

Urinary stress incontinence was treated by the Marshall-Marchetti-Kranz (MMK) procedure in 42 and by Burch coloposuspension in 44 women. All were assessed preoperatively and for greater than 1 year postoperatively, both clinically and by urodynamic tests. Cure of incontinence was achieved to a similar extent by both procedures, in 71% after the MMK and 79% after the Burch operation. Results were better than average if there was no prolapse and if the bladder was stable preoperatively.