Sigma-1 Receptor Inhibition Reduces Mechanical Allodynia and Modulate Neuroinflammation in Chronic Neuropathic Pain

Neuropathic pain is one of the most debilitating forms of chronic pain, resulting from an injury or disease of the somatosensory nervous system, which induces abnormal painful sensations including allodynia and hyperalgesia. Available treatments are limited by severe side-effects and reduced efficacy in the chronic phase of the disease. Sigma-1 receptor (σ1R) has been identified as a chaperone protein, which modulate opioid receptors activities and the functioning of several ion channels, exerting a role in pain transmission. As such, it represents a druggable target to treat neuropathic pain. This study aims at investigating the therapeutic potential of the novel compound (+)-2R/S-LP2, a σ1R antagonist, in reducing painful behaviour and modulating the neuroinflammatory environment. We showed that repeated administration of the compound significantly inhibited mechanical allodynia in neuropathic rats, increasing the withdrawal threshold as compared to CCI-vehicle rats. Moreover, we found that (+)-2R/S-LP2-mediated effects resolve the neuroinflammatory microenvironment by reducing central gliosis and pro-inflammatory cytokines expression levels. This effect was coupled with a significant reduction of connexin 43 (Cx43) expression levels and gap junctions/hemichannels mediated microglia-to-astrocyte communication. These results suggest that inhibition of σ1R significantly attenuates neuropathic pain chronicization, thus representing a viable effective strategy.

Very low serum IGF-1 levels are associated with vertebral fractures in adult males with beta-thalassemia major

PURPOSE

Patients with beta-thalassemia major (BTM) often develop several endocrine disorders due to chronic iron overload. They are also prone to osteoporosis and vertebral fractures. Plasmatic insulin-like growth factor-1 (IGF-1) levels are often low in subjects with BTM, which origin is multifactorial. The aim of this study was to evaluate a possible relationship between serum IGF-1 levels and the presence of osteoporosis and/or vertebral fractures.

METHODS

We retrospectively evaluated the occurrence of vertebral fractures in 30 adult male patients affected by BTM (mean age 43.3 ± 7.9 years) with low serum IGF-1 (median value 52.4 ng/ml, 38.5-83.4). Only 6 of them (20.0%) were diagnosed with GH deficiency (GHD) after GHRH/arginine stimulation test, while 23 (76.7%) had osteoporosis and 12 (40.0%) had known vertebral fractures. All patients except one also showed at least one endocrine disorder.

RESULTS

Serum IGF-1 was significantly lower in BTM patients with vertebral fractures compared to patients without vertebral fractures (U = 41.0, p = 0.005) while it was not significantly different between patients with low bone mass compared to patients without low bone mass. The diagnosis of GHD was significantly associated with lower serum IGF-1 (p = 0.001) and vertebral fractures (p = 0.002) but not with low bone mass. After ROC analysis, we found that very low IGF-1 (≤ 50.0 ng/dl) was associated with vertebral fractures (sensitivity 83.3%, specificity 75.0%) and was also predictive of GHD (sensitivity 75.0%, specificity 100.0%).

CONCLUSION

Our study shows that, in male patients with BTM, serum IGF-1 ≤ 50.0 ng/dl is a marker of vertebral fractures and it is predictive of a diagnosis of GHD.

Temporal trends in the clinical presentation of Graves' orbitopathy: a single-center retrospective study

PURPOSE

Graves' ophthalmopathy (GO) is an autoimmune disease that affects orbital soft tissues and represents the most common extrathyroidal manifestation of Graves' disease (GD). The European Group of Graves' Ophthalmopathy (EUGOGO) has attempted to shed light on the European epidemiological picture of GO, suggesting that GO in newly diagnosed patients in recent years has a trend towards a less severe clinical presentation. There are no studies that focus this issue on the population of our area; we aimed to evaluate the trend of GO clinical presentation in our outpatient clinic through an observation period of 10 years.

METHODS

We compared 55 consecutive patients, 11 males (F) and 44 females (M), who came to our observation from January 2005 to December 2006 [Group 1 (G1)], with 56 patients, 15 males, and 41 females, who were referred to us from 2015 to 2016 [Group 2 (G2)]. We studied the following putative predictors of GO presentation and severity: thyroid function, smoking, diabetes, hypercholesterolemia, time from GO diagnosis to referral to our thyroid centre (TGOD), sex and age.

RESULTS

GO severity was significantly reduced in G2 vs. G1 (p = 0.04). TGOD ≥ 3 months was related to clinical characteristics of GO (severity and Clinical Activity Score ≥ 4) and was an independent predictor of GO severity (p = 0.01). The other variables evaluated had no independent effects.

CONCLUSIONS

We found that GO severity at presentation was significantly reduced over a ten-year observation period (2005-2006 vs. 2015-2016) in GO patients referred to our tertiary thyroid centre. TGOD ≥ 3 months was an independent predictor of GO severity.

Designing drugs optimized for both blood-brain barrier permeation and intra-cerebral partition

INTRODUCTION

With the increasing incidence and prevalence of neurological disorders globally, there is a paramount need for new pharmacotherapies. BBB effectively protects the brain but raises a profound challenge to drug permeation, with less than 2% of most drugs reaching the CNS.

AREAS COVERED

This article reviews aspects of the most recent design strategies, providing insights into ideas and concepts in CNS drug discovery. An overview of the products available on the market is given and why clinical trials are continuously failing is discussed.

EXPERT OPINION

Among the available CNS drugs, small molecules account for most successful CNS therapeutics due to their ability to penetrate the BBB through passive or carrier-mediated mechanisms. The development of new CNS drugs is very difficult. To date, there is a lack of effective drugs for alleviating or even reversing the progression of brain diseases. Particularly, the use of artificial intelligence strategies, together with more appropriate animal models, may enable the design of molecules with appropriate permeation, to elicit a biological response from the neurotherapeutic target.

From Plant to Chemistry: Sources of Antinociceptive Non-Opioid Active Principles for Medicinal Chemistry and Drug Design

Pain is associated with many health problems and a reduced quality of life and has been a common reason for seeking medical attention. Several therapeutics are available on the market, although side effects, physical dependence, and abuse limit their use. As the process of pain transmission and modulation is regulated by different peripheral and central mechanisms and neurotransmitters, medicinal chemistry continues to study novel ligands and innovative approaches. Among them, natural products are known to be a rich source of lead compounds for drug discovery due to their chemical structural variety and different analgesic mechanisms. Numerous studies suggested that some chemicals from medicinal plants could be alternative options for pain relief and management. Previously, we conducted a literature search aimed at identifying natural products interacting either directly or indirectly with opioid receptors. In this review, instead, we have made an excursus including active ingredients derived from plants whose mechanism of action appears from the literature to be other than the modulation of the opioid system. These substances could, either by themselves or through synthetic and/or semi-synthetic derivatives, be investigated in order to improve their pharmacokinetic characteristics and could represent a valid alternative to the opioid approach to pain therapy. They could also be the basis for the study of new mechanisms of action in the approach to this complex and disabling pathology.

From Plant to Chemistry: Sources of Active Opioid Antinociceptive Principles for Medicinal Chemistry and Drug Design

Pain continues to be an enormous global health challenge, with millions of new untreated or inadequately treated patients reported annually. With respect to current clinical applications, opioids remain the mainstay for the treatment of pain, although they are often associated with serious side effects. To optimize their tolerability profiles, medicinal chemistry continues to study novel ligands and innovative approaches. Among them, natural products are known to be a rich source of lead compounds for drug discovery, and they hold potential for pain management. Traditional medicine has had a long history in clinical practice due to the fact that nature provides a rich source of active principles. For instance, opium had been used for pain management until the 19th century when its individual components, such as morphine, were purified and identified. In this review article, we conducted a literature survey aimed at identifying natural products interacting either directly with opioid receptors or indirectly through other mechanisms controlling opioid receptor signaling, whose structures could be interesting from a drug design perspective.

Discovery of AD258 as a Sigma Receptor Ligand with Potent Antiallodynic Activity

The design and synthesis of a series of 2,7-diazaspiro[4.4]nonane derivatives as potent sigma receptor (SR) ligands, associated with analgesic activity, are the focus of this work. In this study, affinities at S1R and S2R were measured, and molecular modeling studies were performed to investigate the binding pose characteristics. The most promising compounds were subjected to in vitro toxicity testing and subsequently screened for in vivo analgesic properties. Compound 9d (AD258) exhibited negligible in vitro cellular toxicity and a high binding affinity to both SRs (KiS1R = 3.5 nM, KiS2R = 2.6 nM), but not for other pain-related targets, and exerted high potency in a model of capsaicin-induced allodynia, reaching the maximum antiallodynic effect at very low doses (0.6-1.25 mg/kg). Functional activity experiments showed that S1R antagonism is needed for the effects of 9d and that it did not induce motor impairment. In addition, 9d exhibited a favorable pharmacokinetic profile.

Experimental characterization of gaseous ion beams produced with the advanced ion source for hadrontherapy (AISHa) at 18 GHz

The Advanced Ion Source for Hadrontherapy (AISHa) is an electron cyclotron resonance ion source operating at 18 GHz, developed at the Istituto Nazionale di Fisica Nucleare-Laboratori Nazionali del Sud, with the aim of producing high intensity and low emittance highly charged ion beams for hadrontherapy purposes. Moreover, thanks to its unique peculiarities, AISHa is a suitable choice for industrial and scientific applications. In the framework of the INSpIRIT and IRPT projects, in collaboration with the Centro Nazionale di Adroterapia Oncologica, new candidates for cancer treatment are being developed. In particular, the paper presents the results of the commissioning of four ion beams of interest for hadrontherapy: H+, C4+, He2+, and O6+. Their charge state distribution in the best experimental conditions, their emittance, and brightness will be critically discussed, along with the role of ion source tuning and space charge effects in beam transport. Perspectives for further developments will also be presented.

New Insights into the Opioid Analgesic Profile of cis-(-)-N-Normetazocine-derived Ligands

In this work, we report on the in vitro and in vivo pharmacological properties of LP1 analogs to complete the series of structural modifications aimed to generate compounds with improved analgesia. To do that, the phenyl ring in the N-substituent of our lead compound LP1 was replaced by an electron-rich or electron-deficient ring and linked through a propanamide or butyramide spacer at the basic nitrogen of the (-)-cis-N-normetazocine skeleton. In radioligand binding assays, compounds 3 and 7 were found to display nanomolar binding affinity for the μ opioid receptor (MOR) (K_i = 5.96 ± 0.08 nM and 1.49 ± 0.24 nM, respectively). In the mouse vas deferens (MVD) assay, compound 3 showed an antagonist effect against DAMGO ([D-Ala², N-MePhe⁴, Gly-ol]-enkephalin), a highly selective MOR prototype agonist, whereas compound 7 produced naloxone reversible effect at MOR. Moreover, compound 7, as potent as LP1 and DAMGO at MOR, was able to reduce thermal and inflammatory pain assessed by the mouse tail-flick test and rat paw pressure thresholds (PPTs) measured by a Randall-Selitto test.

Design, synthesis, in vitro evaluation, and molecular modeling studies of N-substituted benzomorphans, analogs of LP2, as novel MOR ligands

6,7-Benzomorphans have been investigated in medicinal chemistry for developing new drugs. This nucleus could be considered a versatile scaffold. The physicochemical properties of benzomorphan N-substituent are crucial in achieving a definite pharmacological profile at opioid receptors. Thus, the dual-target MOR/DOR ligands LP1 and LP2 were obtained through N-substituent modifications. Specifically, LP2, bearing as N-substituent the (2R/S)-2-methoxy-2- phenylethyl group, is a dual-target MOR/DOR agonist and is successful in animal models of inflammatory and neuropathic pain. To obtain new opioid ligands, we focused on the design and synthesis of LP2 analogs. First, the 2-methoxyl group of LP2 was replaced by an ester or acid functional group. Then, spacers of different lengths were introduced at N-substituent. In-vitro, their affinity profile versus opioid receptors has been performed through competition binding assays. Molecular modeling studies were conducted to deeply analyze the binding mode and the interactions between the new ligands and all opioid receptors.

Do newly arrived migrants represent a COVID-19 burden? Data from the Italian information flow

Background

Migrants who reach host countries irregularly are often perceived as increasing the COVID-19 burden. Italy is a transit and destination country for migrants who cross the Central Mediterranean route. During the pandemic, all migrants who disembarked on the Italian shores have been COVID-19 tested and quarantined. To investigate the incidence of SARS-CoV-2 infection in this population, the INMP, together with the Italian Ministry of the Interior, set a specific information flow collecting data about the infection and possible outcomes.

Methods

The observation period was from January 2021 to January 2022. COVID-19 tests used were molecular and antigenic. Positive cases detected both at the arrival and during the quarantine period, have been registered on an ad hoc INMP online platform. Migrants’ SARS-CoV-2 incidence rate (per 1,000) - with 95% CI - was therefore calculated. The Incidence Ratio (IR) was used to compare the migrants’ incidence rate with that of the resident population in Italy, in the same period and corresponding age group.

Results

Among 70,512 migrants (91% males and 9% females, all <60years old) who landed in Italy during the observation period, 2,861 tested positive, with an incidence rate of 40.6 (39.1-42.1) cases per 1,000. In the same period, an incidence rate of 177.6 (177.5-177.8) has been recorded in the resident population, with an IR of 0.22 (0.22-0.23). 89.9% of cases were males and almost half (49.6%) belonged to the age group 25-39years old. 99% of cases reported no symptoms, no relevant comorbidity has been reported and no cases have been hospitalized.

Conclusions

Our findings clearly highlight the low rate of SARS-CoV-2 infection in migrants reaching Italy by sea with an incidence rate that is roughly a quarter of that of the resident population, encouraging the opportunity to investigate the reasons for such an observation. Moreover, our study confirms the “healthy migrant effect” in migrants reaching Italy by sea.

Key messages

Italian survey on the use of a multidisciplinary approach for age assessment of UAM

Issue

Many methods are used to assess the age of unaccompanied foreign minors (UAM). In Italy, in the frame of a new legislative asset, a multidisciplinary protocol has been adopted in July 2020 with the aim of ensuring that all UAMs are assessed uniformly throughout the country when their age is in doubt. The assessment is based on a multidisciplinary - social, psychological and physical - evaluation performed by a team of specialists. The local health authorities (ASL) carry out the assessment when requested by the Juvenile Court.

Description

One year after the establishment of the protocol, INMP launched a national survey, through an online questionnaire, to investigate the formal adoption of the protocol by the ASL and their adherence in practice. The survey started on 10 January 2022 and closed on 8 March 2022.

Results

Out of 118 ASL that were asked to participate, 102 (85%) answered. 37 declared to have a multidisciplinary team for age assessment. Of them, 18 use the formal protocol, 11 use an approach “in line” with the protocol and 8 have a forensic team, out of the rules of the protocol. Of the 65 that did not set up the team, 22 declared that they were ready to do so. 846 age assessment requests were reported and 687 were carried out. 398 migrants were recognized as minors, 222 migrants were not recognized as minors, and the age of 67 migrants remained uncertain.

Lessons

The pandemic period prevented the effective adoption of the protocol by the ASL, that were strongly engaged in the COVID 19 response. There is still great variability in the way the age assessment of UAMs is conducted and in order to counteract the use of inadequate/outdated practices, it is necessary to actively promote and support the adoption of the protocol. In addition, a continuous comparison/dialogue between the multidisciplinary teams, the Juvenile Court, and the Police Headquarters is also needed, so that the procedure is requested only when necessary and carried out properly.

Key messages

• In case of doubt, the age of all UAM has to be assessed in a uniform manner throughout the country.

• The adoption of the multidisciplinary protocol has to be actively promoted and supported to counter the use of inadequate or outdated assessment practices.

Novel N-normetazocine Derivatives with Opioid Agonist/Sigma-1 Receptor Antagonist Profile as Potential Analgesics in Inflammatory Pain

Although opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common drugs used in persistent pain treatment; they have shown many side effects. The development of new analgesics endowed with mu opioid receptor/delta opioid receptor (MOR/DOR) activity represents a promising alternative to MOR-selective compounds. Moreover, new mechanisms, such as sigma-1 receptor (σ₁R) antagonism, could be an opioid adjuvant strategy. The in vitro σ₁R and σ₂R profiles of previous synthesized MOR/DOR agonists (−)-2R/S-LP2 (1), (−)-2R-LP2 (2), and (−)-2S-LP2 (3) were assayed. To investigate the pivotal role of N-normetazocine stereochemistry, we also synthesized the (+)-2R/S-LP2 (7), (+)-2R-LP2 (8), and (+)-2S-LP2 (9) compounds. (−)-2R/S-LP2 (1), (−)-2R-LP2 (2), and (−)-2S-LP2 (3) compounds have Ki values for σ1R ranging between 112.72 and 182.81 nM, showing a multitarget opioid/σ1R profile. Instead, (+)-2R/S-LP2 (7), (+)-2R-LP2 (8), and (+)-2S-LP2 (9) isomers displayed a nanomolar affinity for σ1R, with significative selectivity vs. σ2R and opioid receptors. All isomers were evaluated using an in vivo formalin test. (−)-2S-LP2, at 0.7 mg/kg i.p., showed a significative and naloxone-reversed analgesic effect. The σ1R selective compound (+)-2R/S-LP2 (7), at 5.0 mg/kg i.p., decreased the second phase of the formalin test, showing an antagonist σ1R profile. The multitarget or single target profile of assayed N-normetazocine derivatives could represent a promising pharmacological strategy to enhance opioid potency and/or increase the safety margin.

Support Asylum and Vulnerabilities through e-health: SAVe as a healthcare continuity tool

Issue

Migrants and refugees (M&Rs) could present different vulnerabilities and health conditions. The high geographical and setting mobility of migrants within the reception system as well as the legal and administrative variability can impact negatively the continuity of care of eventual vulnerabilities and diseases.

Description of the practice

The Italian National Institute for Health Migration and Poverty developed an IC platform to take care of migrant's health over its migration pathway in the hosting country. SAVe guarantees both the health assessment at the border and the following steps of clinical care. It offers specialized tools guiding health professionals to evaluate M&Rs' vulnerabilities as well as infectious and chronic diseases. The electronic system is compliant with the EU-GDPR and includes validated tools such as the WHO (Five) WBI, the EASO tool for special needs identification, the Italian guidelines on Border health checks and the Italian protocol for the unaccompanied minors' age assessment.

Results

The system is being implemented in 4 Italian Regions, where over 28,000 migrants are hosted in reception structures and is expected to be used in the whole Italian reception system. The migrant person is also given the opportunity to save, store and use his health records even in case of relocation to another country.

Lessons

SAVe is turning out as an innovative tool to evaluate vulnerabilities and health of M&Rs who are present in Italy. The use of validated and evidence-based tools improves the confidence of doctors in detecting vulnerabilities and social determinants of health. Its spread at National level is expected to guarantee the continuity of care. Further, the interoperation between SAVe and the National Health File would allow health data collection from the first arrival of migrant until its full integration in the country.

Key messages

SAVe is designed to evaluate comprehensively the health of M&Rs, increase the continuity of care and optimize the healthcare resources. Its socio-health and evidence based approach encourages the use as a benchmark for health data collection and health information sharing.

Managing the pandemic in the reception system for migrants: the Italian experience

Issue

Italy represents a well-known European transit and destination country for Migrants and Refugees (M&Rs) with more than 77.000 migrants currently hosted in the reception system. Pandemic did not impact the M&Rs' influx with more than 30.000 disembarked in 2020. In line with the WHO and international organizations alerts to protect the health of M&Rs, Italy included M&Rs in its pandemic response.

Description of the practice

With the mandate of the Ministry of Health and thanks to the collaboration with the Ministry of the Interior and other institutional and governmental bodies, the Italian National Institute for Health, Migration and Poverty developed a comprehensive strategy to protect M&Rs' health in Italy during the COVID-19 pandemic, either into the reception system and outside.

Results

Interim evidence - based operating procedures including instructions regarding the early detection and the management of potential suspected and confirmed COVID-19 cases, from the first arrival throughout the entire reception system path, have been published. A national survey on the incidence of COVID-19 cases in the reception system has been performed in 2020. Dedicated information flows on the incidence of COVID-19 cases at the arrival in Italy and in the reception system and a periodic monitoring of the implementation of the afore-mentioned operating procedures have been established in 2021. Data collected have shown a daily mean incidence ratio lower for migrants hosted in the reception system than for the general population, as well as the same regarding the new COVID-19 cases among newly arrived migrants.

Lessons

The strategy adopted was found to be effective in protecting M&Rs' health during the pandemic. In particular, the Italian reception system has globally shown a good performance in limiting the COVID-19 spread. Moreover, the influx of newly arrived migrants did not represent an additional epidemiological risk in terms of burden of infection.

Key messages

The production of evidence-based procedures and the establishment of effective information flows have proved to be effective in managing and monitoring the pandemic in regards to M&Rs. The Italian reception system has turned to play as a protective factor in limiting the COVID-19 spread and the systematic screening of newly arrived M&Rs did not shown an additional COVID-19 burden.

Consensus paper on postural dysfunction: recommendations for prevention, diagnosis and therapy

Good fundamentals of posture and balance are essential for the efficient performance of both simple daily tasks and more complex movement patterns. In particular, postural balance is the ability to keep the body in equilibrium and to regain balance after the shift of body segments: postural control mechanisms of integration of the visual, vestibular and foot afferential channels contribute to this. This document provides recommendations based on scientific evidence, clinical practice, and consensus between experts concerning the prevention, diagnosis, and treatment of postural dysfunction at the three stages of life as the developmental age, adult age, and old age > 65 years and follows the "National Guidelines on Classification and Measuring of Posture and its Dysfunctions" per the Italian Ministry of Health (December 2017). The paper answers four main questions: i) "Which measures can be adopted to prevent postural dysfunctions?" ii) "What can we do in order to make a correct diagnosis of postural dysfunction?" iii) "What are the correct treatment programs for postural dysfunctions?" iv) Which professional competencies and experiences are useful for preventing, diagnosing and treating postural dysfunctions? By the Consensus of the Experts and the scientific evidence, emerge that the approach to postural dysfunctions requires a multidisciplinary and interdisciplinary team. Furthermore, rehabilitation treatment interventions must be specific to the age groups that have been indicated, to consider the integration of the main systems and subsystems of postural control that change with age.

Strategies and interventions to effectively prevent and deal with incidences among refugees and migrants, using practical case studies from country level

Member States of the WHO European Region are currently facing high migratory pressure, and violence and injury among refugees and migrants travelling to and living in the Region is a major health risk. The development and implementation of interventions to prevent and effectively deal with such incidences are necessary.

The main findings of the WHO technical guidance Strategies and interventions on preventing and responding to violence and injuries among refugees and migrants will be presented as well as best practice examples from countries. Existing regulations and laws for the prevention of violence and protection of refuges and migrants across the WHO European Region will be discussed as well as recommended strategies and interventions: ensuring safe passage for migrationaddressing causes of violence and injuries in transit and destination countriesidentifying victims and providing care and protectioninvestigating and prosecuting perpetratorsstrengthening the knowledge base

Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties

Objectives

Lockdown measures in response to the coronavirus disease 2019 (COVID-19) pandemic can have serious mental health effects on the population, especially in vulnerable groups, such as those living in poor socio-economic conditions, those who are homeless, migrant workers and asylum seekers/refugees. In addition, these vulnerable groups frequently have greater difficulty accessing health services and in treatment adherence. The aim of this study is to estimate the impact of the COVID-19–related lockdown on service utilisation and follow-up adherence in an Italian mental health outpatient service for migrants and individuals in socio-economic difficulties.

Study design

The design of this study is a retrospective cross-sectional study.

Methods

All patients who visited the mental health outpatient service in the months of February and March in the years 2017–2020 were included in the study. To compare service utilisation before and after the lockdown, the number of patients who visited the mental health outpatient service for psychiatric interview were recorded. Follow-up adherence was calculated as the percentage of patients who visited in February and subsequently attended a follow-up visit in March of the same year.

Results

The number of patients who visited the outpatient service between February 2017 and February 2020 was continuously increasing. In March 2020, fewer patients visited the service for psychiatric interview, in line with the introduction of lockdown measures. In addition, the number of the patients who visited in February 2020 and returned for their follow-up visits in March 2020 declined from approximately 30% over the same months in 2017–2019 to 17.53% in March 2020.

Conclusions

The lockdown-related reduction in numbers of patients accessing the mental health service makes it difficult to help vulnerable populations during a period of time in which their mental health needs are expected to increase. Moreover, the reduction seen in follow-up compliance increases the risk of treatment discontinuation and possible relapse. Proactive alternative strategies need to be developed to reach these vulnerable populations.

•

Lockdown can have serious mental health effects on vulnerable groups.

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These population subgroups also have greater difficulties in accessing health services and maintaining treatment adherence.

•

Access to mental health services and follow-up compliance dramatically dropped as a consequence of lockdown.

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Vulnerable groups are at risk of unmet mental health needs, treatment discontinuation and possible relapse.

•

Proactive alternative strategies need to be developed to reach these vulnerable populations.

Thyroid adenolipoma: a case report

Generally, small quantities of adipose tissue is present in the thyroid gland. The adenolipoma of the thyroid gland is considered a rare finding. It consists in a benign, encapsulated neoplasm composed of mature adipose tissue and glandular elements. We report a case of a 71 year-old female patient presenting with swelling of the anterior neck and history of airway obstruction. Ultrasound (US) examination showed a bulky multinodular goiter which caused dislocation and compression of the trachea. The scans performed at the level of the isthmic region showed the presence of a hyperechoic oval formation with a homogeneous echostructure and regular contours; these characteristics suggested the lipomatous nature of the nodule. The patient was subsequently subjected to a Computer Tomography (CT) of the neck for a pre-operative balance of the goitre and to exclude extra-thyroid pathologies. The CT scan confirmed the sonographic findings, and the probable adipose nature of the isthmic formation. After the patient has been subjected to total thyroidectomy and histological examination confirmed the diagnosis of adenolipoma.

Copeman nodule: a case report

The Copeman nodule is a disease of the subcutaneous soft tissue consisting in subcutaneous adipose tissue herniation through the superficial muscular fascia. A 30-year-old female patient presented with chronic left pain just above the iliac crest. Ultrasound examination showed subcutaneous adipose tissue herniation through the superficial muscular fascia with a hernia gap of 15.9 mm in diameter. Then the patient underwent surgery under local anesthesia with suturing of the hernia gap and immediate regression of chronic pain. Ultrasound can accurately highlight or exclude the presence of Copeman nodule and, in our view, should be used as first examination in patients with superficial chronic pain to the right or left side.

Wilkie's syndrome

Superior mesenteric artery syndrome, also known as Wilkie's syndrome, is a rare vascular disease caused by the anomalous course of the superior mesenteric artery arising from the abdominal aorta with a smaller angle than the norm (<22°). The reduced angle compresses the structures situated between the aorta and the superior mesenteric artery, such as the duodenum and left renal vein; this can determine painful crises, intestinal subocclusions, and left varicocele. This syndrome can be congenital or acquired. The acquired type is more common and is generally caused by reduced perivascular fat surrounding the abdominal aorta and the superior mesenteric artery; this form is common among anorexic patients that have had a rapid weight loss. We present the case of a female patient who suffered from repeated postprandial vomiting and who lost 12 kg in 4 months. B-mode ultrasound imaging revealed evidence of a reduced angle between the aorta and the superior mesenteric artery, as found in Wilkie's syndrome. After diagnosis, the patient followed a high-calorie diet, and 2 months later an ultrasound scan proved the restoration of the aorto-mesenteric angle as a consequence of increased perivascular fat with regression of symptoms.

Distribution of IL28B Polymorphism in a Cohort of Italians and Immigrants with HCV Infection: Association with Viraemia, Stage of Fibrosis and Response to Treatment

Aims of the study are to investigate, in a cohort of patients affected by HCV chronic hepatitis with genotypes 1 and 4, the prevalence of interleukin 28B (IL28B) genotypes, the possible association between IL28B polymorphism and severity of liver damage, the role of IL28B CC as a predictor of outcome. 365 patients with HCV infection were observed between 2013 and 2014. Demographic, virological, biochemical, and genetic characteristics of each patient were investigated. Liver fibrosis was assessed by transient elastometry. Mean age of the patients (72.9 % males, 27.1 % females) is 50 years. 91.5 % % of patients are Caucasian, 8.5 % African. In the patients with HCV1 and HCV4 a higher frequency of IL28B CT is observed with a prevalence of 52.1 and 61.8 % respectively. As regards ethnic group, African people have a prevalence of 35.5 % for CC, while Caucasians have a prevalence of 23.8 % for CC. In our cohort, IL28B polymorphism does not show significant differences among ethnic groups and in HCV1 and HCV4 genotypes. As described in literature, IL28B CC genotype is confirmed as predictor of sustained virological response in both Caucasians and Africans. A significant correlation between liver fibrosis and IL28B polymorphism emerges.

Chlamydia pneumoniae and osteoporosis-associated bone loss: a new risk factor?

We found an association between the presence of Chlamydia pneumoniae DNA both in osteoporotic bone tissue and peripheral blood mononuclear cells (PBMCs) and the increase in circulating resorptive cytokines.

INTRODUCTION

Our study was designed to determine whether C. pneumoniae infection may be involved in osteoporosis-associated bone loss.

METHODS

The study included 59 women undergoing hip joint replacement surgery for femoral neck fracture: 32 with osteoporosis and 27 with osteoarthritis. A total of 118 tissue specimens (59 bone tissues, 59 PBMCs) were examined for C. pneumoniae DNA by real-time polymerase chain reaction (PCR). Serum levels of soluble receptor activator of nuclear factor kappa B ligand (sRANKL), osteoprotegerin (OPG), interleukin (IL)-1β, tumor necrosis factor-α, and IL-6 were also measured.

RESULTS

C. pneumoniae DNA was detected in osteoporotic bone tissue whereas it was not found in non-osteoporotic bone tissue (p < 0.05). A significantly higher rate of C. pneumoniae DNA (p < 0.05) was found in PBMCs of osteoporotic patients than in those of osteoarthritis patients. Among osteoporotic patients, serum sRANKL, IL-1, and IL-6 concentrations as well as sRANKL/OPG ratio significantly differ between patients with bone tissue and PBMCs positive to C. pneumoniae and C. pneumoniae-negative patients.

CONCLUSION

The association between the presence of C. pneumoniae DNA, both in bone tissue and PBMCs, and the increase in sRANKL/OPG ratio as well as in IL-1β and IL-6 levels observed in osteoporotic patients suggests C. pneumoniae infection as a new risk factor for osteoporosis.

Prevalence of latent tuberculosis, syphilis, hepatitis B and C among asylum seekers in Malta

BACKGROUND

In the last few years, Malta has witnessed increasing immigration flows from the Libyan coasts. Public health policies are focused on screening migrants for tuberculosis, whereas no systematic actions against STIs are implemented. The aim of this study is to define the epidemiological profile of asylum seekers in Malta as regards syphilis, hepatitis B, C and latent tuberculosis, thus supporting screening policies.

METHODS

Five hundred migrants living in open centres were screened between December 2010 and June 2011.

RESULTS

83.2% of people was from Somalia, 81.2% males, average age 26.5 years. The tuberculin skin test (TST) was positive in 225 migrants (45%). Latent syphilis was diagnosed in 11 migrants, hepatitis C in 3 and 31 migrants were HBsAg positive.

CONCLUSION

Systematic screening for asymptomatic migrants in Malta is not recommended for hepatitis C and syphilis, given the low prevalence observed. On the contrary, it should be considered for hepatitis B. TST could be indicated as the first step of a two step screening for migrants from countries with high TB incidence. Efficacy and cost-effectiveness could be achieved by further targeting screening to specific subgroups at higher risk of reactivation, such as people living with HIV and subjects affected by chronic diseases.

Changes in matrix extracellular phosphoglycoprotein expression before and during in vitro osteogenic differentiation of human dental papilla mesenchymal cells

The purpose of this study is to characterise the expression of matrix extracellular phosphoglycoprotein (MEPE) in cultured mesenchymal cells isolated from human dental papilla (PaMCs) of impacted third molars either before or during differentiation of these cells into osteo/odontoblasts. PaMCs, like mesenchymal cells deriving from human dental pulp (DPMCs), resulted positive for a number of mesenchymal markers including CD146 and STRO-1. During the first week in culture they showed a faster proliferation rate than DPMCs, coupled to an earlier down-regulation of MEPE. Also when the cells were further cultured in osteogenic medium (containing beta-glycerophosphate, ascorbic acid and dexamethasone) for 40 days, MEPE down-regulation coupled to an increased expression of osteogenic markers, such as osteocalcin and alkaline phosphatase, occurred earlier in PaMCs than in DPMCs. Thus, our data, indicating that also in PaMCs MEPE expression is higher when cells proliferate, whereas it is downregulated as cells differentiated, are in favour of a role of MEPE as an early regulator of odontogenic differentiation. We also confirm the superior proliferative potential of PaMCs in comparison with DPMCs, coupled to a more rapid induction of osteogenic differentiation. Therefore, these cells represent an optimal source to be conveniently used for dental tissue engineering and tooth regeneration.

Morphostructural analysis of human follicular stem cells on highly porous bone hydroxyapatite scaffold

In this study we investigated the in vitro behaviour, morphostructure and extracellular matrix synthesis of human dental follicular stem cells (hDFSCs) isolated from human dental bud, which resulted to be positive for mesenchymal markers (CD29, CD90, CD146 and CD166) by FACS analysis. Cells were analysed by light and electronic microscopy to evaluate their biological response either at week 1, that is before differentiation, or at weeks 3-6, when they had been cultured in osteogenic medium onto a highly porous natural scaffold material (Bio-Oss). Microscopy analysis of primary culture cells showed they had a mesenchymal stem cell-like morphostructure, spindle shaped, similar to the culture of mesenchymal stem cells derived from adult bone marrow. Also, after osteogenic differentiation, these analyses indicate typical osteoblast morphostructure and reveale a tri-dimensional organization of the cells and deposition of extracellular matrix (ECM) in close contact with biomaterial. This approach would allow to personalize the scaffold for bone tissue engineering in order to accelerate the process of osteogenesis.

Experience with asynchronous medical teleconsultation in the Alliance of the Italian hospitals worldwide

A store-and-forward teleconsultation system was established for 36 Italian hospitals located in 22 different countries. Referrals were made to a network of 33 health centres in Italy via a management centre (MC). The MC was equipped with a server to manage the service. The participating hospitals used client workstations with special software. The referring centres generated teleconsultation requests, which were sent to the MC and allocated manually by the latter to the most appropriate specialist on the basis of information provided in the message. From 1 June 2005 to 15 March 2006, 187 enquiries out of 221 were answered. The median response time was two days. A service satisfaction survey was conducted among the users and about 90% of the responses were positive. The teleconsultation system represents a mechanism for providing equitable access to health care for all the referring doctors.

Immunohistochemical evaluation of CD31 in human cystic radicular lesions and in keratocysts

Platelet-endothelial cell adhesion molecule-1 protein (PECAM-1/CD31) is expressed in numerous physiological and pathological processes characterized by an increase of vascular permeability, and in normal and tumour tissues. CD31, member of the immunoglobulin super-family that mediates cell-to-cell adhesion, is a transmembrane glycoprotein, 130-140 kDa, also know as platelet-endothelium cell adhesion molecule (PECAM-1). CD31 is a ligand for CD38 and plays a role in thrombosis and angiogenesis. CD31 is strongly expressed in endothelial cells and weakly expressed in megakaryocytes, platelets, occasional plasma cells, lymphocytes (marginal zone B-cells, peripheral T-cells) and neutrophils. The present study evaluates the angiogenetic processes which are accompanied by an expansion of cystic radicular and keratocystic lesions of the jaw bone. Twelve subjects with maxillary cysts (8 males and 4 females) with an average age of 43 years were selected by the Chieti University Oral Surgery Department. The surgical samples taken were subjected to histological and immunohistochemical analysis. The histological evaluation confirmed the diagnosis of radicular cystisis and keratocystisis. The immunohistochemical analyses were positive for CD31 protein in all the lesions analysed, even though they had different intensities. Using a semiquantive analysis it was possible to highlight, in the radicular cyst samples, an intense expression of the vascular component both in the inflamed area and the adjacent stroma. The lesions with cheratin content showed newly-formed, rather modest, vascularity both in the area showing slight inflammation, where the cellular component is prevalent, and in the adjacent areas showing no sign of inflammation. Therefore, in our observations, angiogenesis could take on a primary role in the development of cystic lesions of the jaw bones. The differences of CD31 expression, in all samples, would advise for a wider monitoring able to evaluate the possible use of such a protein as a diagnostic marker.

Effect of cilomilast (Ariflo) on TNF-alpha, IL-8, and GM-CSF release by airway cells of patients with COPD

BACKGROUND

Inflammation in chronic obstructive pulmonary disease (COPD) is characterised by increased neutrophilic infiltration of the airways. Cilomilast, a novel selective phosphodiesterase 4 inhibitor in clinical development for COPD treatment, exerts anti-inflammatory effects. The ability of cilomilast to inhibit the release of neutrophil chemoattractants such as tumour necrosis factor (TNF)-alpha, interleukin (IL)-8, and granulocyte-macrophage colony stimulating factor (GM-CSF) by bronchial epithelial cells and sputum cells isolated from 10 patients with COPD, 14 normal controls, and 10 smokers was investigated.

METHODS

Bronchial epithelial cells obtained by bronchial brushing and sputum cells isolated from induced sputum samples were cultured for 24 hours in the presence or absence of cilomilast (1 micro M). After incubation the supernatants were harvested and the levels of mediators measured by ELISA. Chemotactic activity in supernatants was also measured using a Boyden chamber.

RESULTS

TNF-alpha and IL-8 release by bronchial epithelial cells and sputum cells was higher in patients with COPD than in controls (p<0.0001) and smokers (p<0.0001). GM-CSF was only detectable in sputum cell supernatants and its level was higher in patients with COPD than in controls and smokers (p<0.0001, respectively). Cilomilast significantly reduced TNF-alpha release by bronchial epithelial cells and sputum cells (p=0.005) and GM-CSF release by sputum cells (p=0.003), whereas IL-8 release was not statistically inhibited. Supernatants of sputum cells and bronchial epithelial cells treated with cilomilast significantly decreased neutrophil chemotaxis (p<0.006 and p<0.008, respectively).

CONCLUSIONS

Cilomilast inhibits the production of some neutrophil chemoattractants by airway cells. This drug may play a role in the resolution of neutrophilic inflammation associated with COPD and cigarette smoke.

Preliminary study of gene expression levels in human T-cells exposed to cosmic radiations

Several experiments demonstrated the influence of microgravity on mitogenic activation of T cells at molecular level. To discriminate between effects of microgravity and cosmic radiations, in this work we studied the effects of high cosmic radiations on the genetic expression in human T cells boarded in a stratospheric balloon (BIRBA-1 mission, 22 hours of flight). The genetic expression was analyzed by the cDNA microarray hybridization technology, which allows the comparative and simultaneous estimate of hundreds of mRNAs Activated cells react to the ionizing stress by activating genes involved in cell cycle check-point, oxidative stress response, heat shock proteins production or by repressing genes involved in antigen recognition.

A possible prebiotic synthesis of purine, adenine, cytosine, and 4(3H)-pyrimidinone from formamide: implications for the origin of life

The synthesis of prebiotic molecules is a major problem in chemical evolution as well as in any origin-of-life theory. We report here a plausible new prebiotic synthesis of naturally occurring purine and pyrimidine derivatives from formamide under catalytic conditions. In the presence of CaCO(3) and different inorganic oxides, namely silica, alumine, kaolin, and zeolite (Y type), neat formamide undergoes the formation of purine, adenine, cytosine, and 4(3H)-pyrimidinone, from acceptable to good yields. The role of catalysts showed to be not limited to the improvement of the yield but it is also relevant in providing a high selectivity in the products distribution.

Cell cycle arrest determines the intensity of the global transcriptional response of Saccharomyces cerevisiae to ionizing radiation

Whole-genome analysis was performed using DNA microarrays to define the changes in the gene expression patterns occurring in Saccharomyces cerevisiae cells exposed to ionizing radiation. The effects of sublethal dose on wild-type, rad53 (enhanced sensitivity to radiation and impaired in a cell cycle damage checkpoint), and rad6 (enhanced sensitivity to radiation and functional cell cycle block by radiation) mutant backgrounds and of a higher dose on the wild-type and G(2)-phase-arrested cells were analyzed. Several gene pathways were identified as being implicated in the response to radiation. In particular, the cell cycle blockage that occurred in the wild-type strain after a high radiation dose and in the rad6 mutant after a lower dose entailed modifications of defined gene expression patterns, which are described here and are compared with the gene modulation patterns observed in the rad53 strain in the absence of efficient blockage. Loss of the RAD53 function caused a major increase in the number of genes modulated by radiation. Given that Rad53-Sad1p, the protein encoded by RAD53, has functions other than those directly connected to cell cycle arrest, we determined the gene patterns that were modulated upon irradiation of rad53 cells that had been forced to arrest in G(2) phase by nocodazole treatment. These differential whole-genome analyses shed light on the multiplicity of functions of the pivotal Rad53-Sad1p protein. The results obtained describe how the cells respond to different irradiation conditions by modulating important gene classes, including those associated with stress defense, ribosomal proteins, histones, ergosterol and GCR1-controlled sugar metabolism.

The sea urchin sns insulator blocks CMV enhancer following integration in human cells

Insulators are a new class of genetic elements that attenuate enhancer function directionally. Previously, we characterized in sea urchin a 265-bp-long insulator, termed sns. To test insulator activity following stable integration in human cells, we placed sns between the CMV enhancer and a tk promoter upstream of a GFP transgene of plasmid or retroviral vectors. In contrast to controls, cells transfected or transduced with insulated constructs displayed a barely detectable fluorescence. Southern blot and PCR ruled out vector rearrangement following integration into host DNA; RNase protection confirmed the enhancer blocking activity. Finally, we demonstrate that two cis-acting sequences, previously characterized in sea urchin, are also specific binding sites for human proteins. We conclude that sns interferes with enhancer promoter interaction also in a human chromatin context. The relatively small size, evolutionary conservation and apparent lack of enhancer specificity might result useful in gene transfer experiments in human cells.

RNA polymerase III transcription complexes on chromosomal 5S rRNA genes in vivo: TFIIIB occupancy and promoter opening

Quantitative analysis of multiple-hit potassium permanganate (KMnO(4)) footprinting has been carried out in vivo on Saccharomyces cerevisiae 5S rRNA genes. The results fix the number of open complexes at steady state in exponentially growing cells at between 8 and 17% of the 150 to 200 chromosomal copies. UV and dimethyl sulfate footprinting set the transcription factor TFIIIB occupancy at 23 to 47%. The comparison between the two values suggests that RNA polymerase III binding or promoter opening is the rate-limiting step in 5S rRNA transcription in vivo. Inhibition of RNA elongation in vivo by cordycepin confirms this result. An experimental system that is capable of providing information on the mechanistic steps involved in regulatory events in S. cerevisiae cells has been established.

Differential gene expression in p53-mediated G(1) arrest of human fibroblasts after gamma-irradiation or N-phosphoacetyl-L-aspartate treatment

In human fibroblasts, N:-phosphoacetyl-L-aspartate (PALA) and gamma-radiation induce reversible and irreversible p53-mediated G(1) cell cycle arrest, respectively. By coupling the premature chromosome condensation technique to fluorescence in situ hybridization, we found no evidence of DNA damage after PALA treatment. We used representational difference analysis (cDNA-RDA) to study changes in gene expression after PALA treatment and gamma-radiation in normal human fibroblasts. The mammary-derived growth inhibitor (MDGI) gene was expressed in PALA-treated cells. Ectopic MDGI expression arrested PALA-treated but not irradiated RKO cells. Expression of an antisense RNA against MDGI resulted in partial G(1) escape of PALA-treated human fibroblasts. The tumor necrosis factor stimulated gene 6, TSG-6, seems to be under the control of p53 and is only and specifically induced upon PALA treatment. In irradiated cells we have identified 'novel' genes that are differentially expressed, along with known genes not previously linked to cell cycle control. Some of these 'novel' genes correspond to clones in the expressed sequence tag (EST) database; one of them shows identity with ESTs mapping to a region on chromosome 7, where gene(s) involved in replicative senescence and frequently deleted in tumors are located. Thus, PALA treatment and gamma-irradiation elicit a pattern of differential gene expression that could contribute to a quiescence or senescence-like phenotype.

Vertebral instability in non-neurologic thoracolumbar fractures: the predictive value of methods of measurement

It is the purpose of this study to evaluate the radiographic results of the conservative treatment of fractures of the thoracolumbar passage in relation to the initial and long-term injury parameters measured by using three different methods: the sagittal index (SI), by Farcy et al., the McRae Index, the Knight et al. Index. The predictive value for each single method was calculated, to determine which of them could be reliable for the purposes of defining primary stability of the injured spine segment. The three methods of measurement were used for initial evaluation and at follow-up (mean 31 months; range 9-45) in 60 non-neurologic thoracolumbar fractures treated conservatively. The fractures were classified based on Magerl et al. Initial instability was evaluated on the basis of the progression of the kyphotic deformity (by at least 5 Cobb degrees as compared to the pre-treatment condition). The Pearson chi 2 test was used for a statistical analysis of the data. There was progression in kyphosis of the fracture in 36 cases (60%). The sagittal index (SI) measured on initial X-rays revealed 27 (76%) potentially stable fractures, while the McRae Index considered 19 to be at risk (55%), the Knight Index, 15 (43%). The higher predictive value (73%) of the sagittal index shows the greater reliability of this method of measurement, as compared to the McRae Index (predictive value = 60%) and the Knight Index (53%) in recognizing the initial phases to be those where the potential instability of the fracture is observed. Even when the SI is applied, the probability of an error in evaluation occurring is 27%. This fact once again stresses the need for more accurate radiological examinations (CT scan, MRI) that clarify the morphological aspects of the lesion injury in an exact manner.

Changing nucleosome positions in vivo through modification of the DNA rotational information

The effects of the rotational information of DNA in determining the in vivo localization of nucleosomal core particles (ncps) have been studied in the Saccharomyces cerevisiae 5 S rRNA repeat gene. The distribution of the phased series of flexibility signals present in this DNA has been altered by inserting in its centre a 25 bp tract. The effects of such alteration on the in vivo distribution of the helically phased, alternatively located ncps have been determined relative to a reference 21 bp insertion mutant. The results show that the answers provided in vitro and in vivo by the yeast 5 S rRNA gene sequence to specific modifications of the DNA rotational frame are similar, thus pointing to the relevance of DNA rotational information in vivo.

Mechanism of degradation of 2'-deoxycytidine by formamide: implications for chemical DNA sequencing procedures

We describe the reaction of formamide with 2'-deoxycytidine to give pyrimidine ring opening by nucleophilic addition on the electrophilic C(6) and C(4) positions. This information is confirmed by the analysis of the products of formamide attack on 2'-deoxycytidine, 5-methyl-2'-deoxycytidine, and 5-bromo-2'-deoxycytidine, residues when the latter are incorporated into oligonucleotides by DNA polymerase-driven polymerization and solid-phase phosphoramidite procedure. The increased sensitivity of 5-bromo-2'-deoxycytidine relative to that of 2'-deoxycytidine is pivotal for the improvement of the one-lane chemical DNA sequencing procedure based on the base-selective reaction of formamide with DNA. In many DNA sequencing cases it will in fact be possible to incorporate this base analogue into the DNA to be sequenced, thus providing a complete discrimination between its UV absorption signal and that of the thymidine residues. The wide spectrum of different sensitivities to formamide displayed by the 2'-deoxycytidine analogues solves, in the DNA single-lane chemical sequencing procedure, the possible source of errors due to low discrimination between C and T residues.

[Review of 87 cases of scoliosis surgically treated]

BACKGROUND

The authors compared the results and complications in surgical treatment of idiopathic scoliosis with Harrington's rod instrumentation with subtrasversal wires in dorsal treat.

METHODS

A research on 87 cases operated on for idiopathic scoliosis from 1987 to 1995 is carried out. The 87 cases include 65 females and 25 males, 16 years old in average (range, 11 to 30). The curvature in Cobb's degrees and rotation of vertebrae with Raimondi's method on radiographs take just before, 15 days later and an year later on operation was measured. The patients have been divided into two groups: the first of 77 patients operated with Harrington's rod instrumentation; the second of 10 patients operated with Harrington's rod instrumentation and subtrasversal wires.

RESULTS

In a general analysis without taking in to consideration the type and the seriousness of curvature it was obtained a better correction and derotation of vertebrae in patients of second group. The same group with wires had obtained a better correction and derotation of vertebrae in dorsal scoliosis from 40 degrees to 60 degrees and in the double scoliosis, while the first group obtained better results in dorsal scoliosis from 60 degrees to 80 degrees and in derotation of vertebrae on dorsal treat of double scoliosis. One case of pseudarthrosis in every group was observed. Any neurological complication were observed.

CONCLUSIONS

The conclusions is drawn that the application of subtrasversal wire improves the Harrington's technique for the correction and derotation of dorsal and double scoliosis without neurological complications sometimes present with subliminar wires.

[Leiomyoma of the small intestines--a rare cause of emergency abdominal surgery]

The authors underline that, although rarely found, leiomyomas of the gastrointestinal tract are the most frequent benign tumours of the small intestine. On occasions, from being a simple autoptic finding or diagnosed during the course of explorative laparotomy, they may be responsible for emergency abdominal surgery, hemorrhage, occlusion or perforation. The authors discuss the experience acquired in two cases-treated during the last two years, both of which were symptomatic. In one case there was a palpable abdominal mass, and in both the key symptom was the appearance of melena a few days before being admitted to hospital. The most striking problem of this rare pathology is its diagnosis owing to both the absence of a specific clinical symptoms, and the difficulties shown in radiological diagnostics of the small intestine. In the authors' experience CAT using a contrast medium is an important instrument, whereas clyster of the small intestine is of scarce value. Explorative laparotomy was essential for removing any doubts regarding diagnosis. Both patients underwent extensive intestinal resection, including the mass and relative mesenteric wedge, with TT single-layer anastomosis. The postoperative period was normal.

One-step, one-lane chemical DNA sequencing by N-methylformamide in the presence of metal ions

We report on a chemical method that allows DNA sequencing by a single reaction. It is based on treatment of 5'-end-labeled DNA with N-methylformamide in the presence of manganese. This method allows the manipulation of samples to be kept to a minimum and consists of a single chemical step that requires about 30 minutes to complete base degradation, phosphodiester bond cleavage and denaturation. Examples of one-treatment, one-lane DNA sequencing of both radioactively and fluorescently 5'-end-labeled DNAs are reported.