Development of a standardized methodology for transfer learning with QSAR models: a purely data-driven approach for source task selection

Transfer learning is a machine learning technique that works well with chemical endpoints, with several papers confirming its efficiency. Although effective, because the choice of source/assistant tasks is non-trivial, the application of this technique is severely limited by the domain knowledge of the modeller. Considering this limitation, we developed a purely data-driven approach for source task selection that abstracts the need for domain knowledge. To achieve this, we created a supervised learning setting in which transfer outcome (positive/negative) is the variable to be predicted, and a set of six transferability metrics, calculated based on information from target and source datasets, are the features for prediction. We used the ChEMBL database to generate 100,000 transfers using random pairing, and with these transfers, we trained and evaluated our transferability prediction model (TP-Model). Our TP-Model achieved a 135-fold increase in precision while achieving a sensitivity of 92%, demonstrating a clear superiority against random search. In addition, we observed that transfer learning could provide considerable performance increases when applicable, with an average Matthews Correlation Coefficient (MCC) increase of 0.19 when using a single source and an average MCC increase of 0.44 when using multiple sources.

Predictors of intubation in COVID-19 patients treated with out-of-ICU continuous positive airway pressure

BACKGROUND

As delayed intubation may worsen the outcome of coronavirus disease 2019 (COVID-19) patients treated with continuous positive airway pressure (CPAP), we sought to determine COVID-specific early predictors of CPAP failure.

METHODS

In this observational retrospective multicentre study, we included all COVID-19 patients treated with out-of-ICU CPAP, candidates for intubation in case of CPAP failure. From these patients, we collected demographic and clinical data.

RESULTS

A total of 397 COVID-19 patients were treated with CPAP for respiratory failure, with the therapeutic goal of providing intubation in case of CPAP failure. Univariable analysis showed that, age, lactate dehydrogenase (LDH) and white cell counts were all significantly lower in patients with successful CPAP treatment compared to those failing it and undergoing subsequent intubation. The percentage changes between baseline and CPAP application in the ratio of partial pressure arterial oxygen (PaO₂) and fraction of inspired oxygen (FiO₂), PaO_2, respiratory rate and ROX index were higher in patients experiencing successful CPAP compared to those failing it. FiO₂ and male gender were also significantly associated with intubation. Multivariable analysis adjusting for age, gender, Charlson comorbidity index, percentage change in PaO₂/FiO₂ or PaO₂ and FiO₂ separately, lactate, white blood cell count, LDH and C-reactive protein levels led to an area under the curve of 0.818 and confirmed that age, LDH and percentage increase in PaO₂/FiO₂ are predictors of intubation.

CONCLUSIONS

In COVID-19 patients requiring CPAP, age, LDH and percentage change in PaO₂/FiO₂ after starting CPAP are predictors of intubation.

Cell-based multi-target QSAR model for design of virtual versatile inhibitors of liver cancer cell lines

Liver cancers are one of the leading fatal diseases among malignant neoplasms. Current chemotherapeutic treatments used to fight these illnesses have become less efficient in terms of both efficacy and safety. Therefore, there is a great need of search for new anti-liver cancer agents and this can be accelerated by using computer-aided drug discovery approaches. In this work, we report the development of the first cell-based multi-target model based on quantitative structure-activity relationships (CBMT-QSAR) for the design and prediction of chemicals as anticancer agents against 17 liver cancer cell lines. While having a good quality and predictive power (accuracy higher than 80%) in the training and test sets, respectively, the CBMT-QSAR model was employed as a tool to directly extract suitable fragments from the physicochemical and structural interpretations of the molecular descriptors. Some of these desirable fragments were assembled, leading to the virtual design of eight molecules with drug-like properties, with six of them being predicted as versatile anticancer agents against the 17 liver cancer cell lines reported here.

Analytical techniques to recognize inclusion complexes formation involving monoterpenes and cyclodextrins: A study case with (-) borneol, a food ingredient

Monoterpenes are non-polar secondary metabolites widely used by industry due to their excellent therapeutic, food-ingredient and cosmetic properties. However, their low solubility in water limits their use. In this sense, cyclodextrins (CDs) have been widely used to solve these technological challenges. Thus, this study aims to use (-)-borneol as a monoterpene model to prepare inclusion complexes between β-CD and hydroxypropyl-β-CD (HP-β-CD) through different ways and characterize them in order to choose the best inclusion method to improve physicochemical properties of monoterpenes. To achieve this goal, the samples were prepared by physical mixture (PM), paste complex (PA) and freeze-drying complex (FD) and then, extensively characterized by thermal analysis, Fourier-transform infrared spectroscopy, scanning electron microscopy, size particle, X-ray diffraction and nuclear magnetic resonance. The physicochemical results showed that freeze-drying was more effective to form inclusion complexes between (-)-borneol with both CDs. This research highlights the importance of recognizing the best method to prepare inclusion complexes, including food additives as (-)-borneol, to achieve better results in food preparations.

[The use of RCGO triggers in the obstetric - gynecological procedures: the impact on the reduction of adeverse events. The experience of the Lombardia Region]

The last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until the end of pregnancy. The adverse events during labor and childbirth can have very serious physical, psychological and financial consequences for the child, the family, health professionals and the whole community. These events can be reduced through interventions aimed at improving the safety and quality of care, based on evidence-based knowledge, guidelines and practices that must be widely and effectively applied. This work reports the experience of the Lombardy Region on improvement actions in the obstetric and gynecological procedures for the reduction of adverse events and sentinel events through the monitoring and management of the RCGS trigger tool.

Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy

PURPOSE

The study aimed to fill existing knowledge gaps on the safety of antidepressant drugs (ADs) by estimating the risk of hospitalization for arrhythmia associated with use of selective serotonin reuptake inhibitors (SSRIs) and newer atypical ADs (NAAs) among elderly with previous cardiovascular (CV) events.

METHODS

The cohort was composed by 199,569 individuals aged ≥ 65 years from five Italian healthcare territorial units who were discharged for cardiovascular outcomes in the years 2008-2010. The 17,277 patients who experienced hospital admission for arrhythmia during follow-up were included as cases. Odds of current ADs use among cases (i.e., 14 days before hospital admission) was compared with (i) odds of current use of 1:5 matched controls (between-patients case-control) and with (ii) odds of previous use during 1:5 matched control periods (within-patient case-crossover). The risk of arrhythmia associated with ADs current use was modelled fitting a conditional logistic regression. A set of sensitivity analyses was performed to account for sources of systematic uncertainty.

RESULTS

Current users of SSRIs and NAAs were at increased risk of arrhythmia with case-control odds ratios (OR) of 1.37 (95% confidence interval, CI 1.18 to 1.58) and 1.41 (1.16 to 1.71) and case-crossover OR of 1.48 (1.20 to 1.81) and 1.72 (1.31 to 2.27). An increased risk of arrhythmia was associated with current use of trazodone (NAA) consistently in case-control and case-crossover designs.

CONCLUSIONS

Evidence that current use of SSRIs and NAAs is associated to an increased risk of arrhythmia among elderly with CV disease was consistently supplied by two observational approaches.

Statin use and risk of new-onset diabetes: A meta-analysis of observational studies

BACKGROUND AND AIMS

Meta-analyses of randomized control trials investigating the association between incident diabetes and statin use showed an increased risk of new-onset diabetes (NOD) from 9% to 13% associated with statins. However, short follow-up period, unpowered sample size, and lack of pre-specified diagnostic criteria for diabetes detection could be responsible of an underestimation of this risk. We conducted a meta-analysis of published observational studies to evaluate the association between statins use and risk of NOD.

METHODS AND RESULTS

PubMed, EMBASE and MEDLINE databases were searched from inception to June 30, 2016 for cohort and case-control studies with risk of NOD in users vs nonusers, on ≥1000 subjects followed-up for ≥1 year. Two review authors assessed study eligibility and risk of bias and undertook data extraction independently. Pooled estimates were calculated by a random-effects model and between-study heterogeneity was tested and measured by I² index. Furthermore, stratified analyses and the evaluation of publication bias were performed. Finally, the meta-analysis included 20 studies, 18 cohort and 2 case-control studies. Overall, NOD risk was higher in statin users than nonusers (RR 1.44; 95% CI 1.31-1.58). High between-study heterogeneity (I² = 97%) was found. Estimates for all single statins showed a class effect, from rosuvastatin (RR 1.61; 1.30-1.98) to simvastatin (RR 1.38; 1.19-1.61).

CONCLUSIONS

The present meta-analysis confirms and reinforces the evidence of a diabetogenic effect by statins utilization. These observations confirm the need of a rigorous monitoring of patients taking statins, in particular pre-diabetic patients or patients presenting with established risk factors for diabetes.

Can healthcare utilization data reliably capture cases of chronic respiratory diseases? a cross-sectional investigation in Italy

BACKGROUND

Healthcare utilization data are increasingly used for chronic disease surveillance. Nevertheless, no standard criteria for estimating prevalence of high-impact diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, are available. In this study an algorithm for recognizing COPD/asthma cases from HCU data is developed and implemented in the HCU databases of the Italian Lombardy Region (about 10 million residents). The impact of diagnostic misclassification for reliably estimating prevalence was also assessed.

METHODS

Disease-specificdrug codes, hospital discharges together with co-payment exemptions when available, and a combination of them according with patient's age, were used to create the proposed algorithm. Identified cases were considered for prevalence estimation. An external validation study was also performed in order to evaluate systematic uncertainty of prevalence estimates.

RESULTS

Raw prevalence of COPD and asthma in 2010 was 3.6 and 3.3% respectively. According to external validation, sensitivity values were 53% for COPD and 39% for asthma. Adjusted prevalence estimates were respectively 6.8 and 8.5% for COPD (among person aged 40 years or older) and asthma (among person aged 40 years or younger).

CONCLUSIONS

COPD and asthma prevalence may be estimated from HCU data, albeit with high systematic uncertainty. Validation is recommended in this setting.

Sphingosine-1-phosphate restores endothelial barrier integrity in ovarian hyperstimulation syndrome

STUDY QUESTION

Are follicular fluid (FF) sphingosine-1-phosphate (S1P) levels in patients at risk of developing ovarian hyperstimulation syndrome (OHSS) altered and in part responsible for the high vascular permeability observed in these patients.

STUDY ANSWER

FF S1P levels are lower in FF from patients at risk of OHSS and treatment with S1P may reduce vascular permeability in these patients.

WHAT IS KNOWN ALREADY

Although advances have been made in the diagnosis, and management of OHSS and in basic knowledge of its development, complete prevention has proven difficult.

STUDY DESIGN, SIZE, DURATION

A total of 40 FF aspirates were collected from patients undergoing ART. The women (aged 25-39 years old) were classified into a control group (n = 20) or a group at risk of OHSS (n = 20). The EA.hy926 endothelial cell line was used to assess the efffects of FF from patients at risk of OHSS with or without the addition of S1P. An animal model that develops OHSS in immature Sprague-Dawley rats were also used.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Migration assays, confocal microscopy analysis of actin filaments, immunoblotting and quail chorioallantoic membrane (CAM) assays of in-vivo angiogenesis were performed and statistical comparisons between groups were made.

MAIN RESULTS AND THE ROLE OF CHANCE

The S1P concentration was significantly lower in FF from patients at risk of OHSS (P = 0.03). The addition of S1P to this FF decreased cell migration (P < 0.05) and prevented VE-cadherin phosphorylation in endothelial cells (P < 0.05). S1P in the FF from patients at risk of OHSS increased the levels of VE-cadherin (P < 0.05), N-cadherin (P < 0.05) and β-catenin (P < 0.05), and partially reversed actin redistribution in endothelial cells. The addition of S1P in FF from patients at risk of OHSS also decreased the levels of vascular endothelial growth factor (VEGF₁₂₁; P < 0.01) and S1P lyase (SPL; P < 0.05) and increased the levels of S1PR1 (P < 0.05) in endothelial cells. In CAMs incubated with FF from patients at risk of OHSS with S1P, the number of vessel branch points decreased while the periendothelial cell coverage increased. Additionally, in a rat OHSS model, we demonstrated that vascular permeability and VEGF₁₂₁ and its receptor KDR expression were increased in the OHSS group compared to the control group and that S1P administration decreased these parameters.

LARGE SCALE DATA

N/A.

LIMITATIONS, REASONS FOR CAUTION

The results of this study were generated from an in-vitro system. This model reflects the microvasculature in vivo. Even though the ideal model would be the use of human endothelial cells from the ovary, it is obviously not possible to carry out this kind of approach in ovaries of patients from ART. More studies will be necessary to delineate the effects of S1P in the pathogenesis of OHSS. Hence, clinical studies are needed in order to choose the most appropriate method of prevention and management.

WIDER IMPLICATIONS OF THE FINDINGS

The use of bioactive sphingolipid metabolites may contribute to finding better and safer therapeutic strategies for the treatment of OHSS and other human diseases that display aberrant vascular leakage.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by grants ANPCyT (PICT 2012-897), CONICET (PIP 5471), Roemmers and Baron Foundation, Argentina. The authors declare no conflict of interest.

Design, synthesis, molecular docking and biological evaluation of thiophen-2-iminothiazolidine derivatives for use against Trypanosoma cruzi

In this study, we designed and synthesized a series of thiophen-2-iminothiazolidine derivatives from thiophen-2-thioureic with good anti-Trypanosoma cruzi activity. Several of the final compounds displayed remarkable trypanocidal activity. The ability of the new compounds to inhibit the activity of the enzyme cruzain, the major cysteine protease of T. cruzi, was also explored. The compounds 3b, 4b, 8b and 8c were the most active derivatives against amastigote form, with significant IC50 values between 9.7 and 6.03μM. The 8c derivative showed the highest potency against cruzain (IC50=2.4μM). Molecular docking study showed that this compound can interact with subsites S1 and S2 simultaneously, and the negative values for the theoretical energy binding (Eb=-7.39kcal·mol(-1)) indicates interaction (via dipole-dipole) between the hybridized sulfur sp(3) atom at the thiazolidine ring and Gly66. Finally, the results suggest that the thiophen-2-iminothiazolidines synthesized are important lead compounds for the continuing battle against Chagas disease.

Risk of cardiac valvulopathy with use of bisphosphonates: a population-based, multi-country case-control study

Analyses of healthcare data from 30 million individuals in three countries showed that current use of bisphosphonates may be associated with a small increased risk of cardiac valvulopathy (vs. those not exposed within the previous year), although confounding cannot be entirely ruled out. The observed tendency for decreased valvulopathy risk with cumulative duration of bisphosphonate use >6 months may even indicate a protective effect with prolonged use. Further studies are still needed to evaluate whether bisphosphonates increase or decrease the risk of valvulopathy.

INTRODUCTION

A signal of cardiac valve disorders with use of bisphosphonates was identified in the literature and EudraVigilance database, which contains reports of suspected adverse drug reactions from worldwide sources. The aim of this study was to evaluate the association using population-based healthcare data.

METHODS

This was a case-control study among users of bisphosphonates and other drugs for osteoporosis in six healthcare databases covering over 30 million individuals in Italy, Netherlands and the UK from 1996 to 2012. Prescriptions/dispensations were used to assess drug exposure. Newly diagnosed cases of cardiac valvulopathy were identified via disease codes/free-text search. Controls were matched to each case by age, sex, database and index date. Adjusted odds ratios (ORs) were estimated using conditional logistic regression for the pooled data and meta-analysis of individual database risk estimates.

RESULTS

A small but statistically significant association was found between exposure to bisphosphonates as a class and risk of valvulopathy. Overall risk was 18 % higher (95 % CI 12-23 %) in those currently exposed to any bisphosphonate (mainly alendronate and risedronate) vs. those not exposed within the previous year. Risk of valve regurgitation was 14 % higher (95 % CI 7-22 %). Decreased valvulopathy risk was observed with longer cumulative duration of bisphosphonate use, compared to use of less than 6 months. Meta-analyses of database-specific estimates confirmed results from pooled analyses.

CONCLUSIONS

The observed increased risks of cardiac valvulopathy with bisphosphonate use, although statistically significant, were quite small and unlikely to be clinically significant. Further studies are still needed to evaluate whether bisphosphonates increase or decrease the risk of valvulopathy and to investigate possible mechanisms for the association.

Extracellular histones reduce survival and angiogenic responses of late outgrowth progenitor and mature endothelial cells

ESSENTIALS: Extracellular histones are highly augmented in sites of neovessel formation, such as regeneration tissues. We studied histone effect on survival and angiogenic activity of mature and progenitor endothelial cells. Extracellular histones trigger apoptosis and pyroptosis and reduce angiogenesis in vivo and in vitro. Histone blockade can be useful as a therapeutic strategy to improve angiogenesis and tissue regeneration.

BACKGROUND

Extracellular histones are highly augmented in sites of neovessel formation, like regeneration tissues. Their cytotoxic effect has been studied in endothelial cells, although the mechanism involved and their action on endothelial colony-forming cells (ECFCs) remain unknown.

OBJECTIVE

To study the effect of histones on ECFC survival and angiogenic functions and compare it with mature endothelial cells.

METHODS AND RESULTS

Nuclear morphology analysis showed that each human recombinant histone triggered both apoptotic-like and necrotic-like cell deaths in both mature and progenitor endothelial cells. While H1 and H2A exerted a weak toxicity, H2B, H3 and H4 were the most powerful. The percentage of apoptosis correlated with the percentage of ECFCs exhibiting caspase-3 activation and was zeroed by the pan-caspase inhibitor Z-VAD-FMK. Necrotic-like cell death was also suppressed by this compound and the caspase-1 inhibitor Ac-YVAD-CMK, indicating that histones triggered ECFC pyroptosis. All histones, at non-cytotoxic concentrations, reduced migration and H2B, H3 and H4 induced cell cycle arrest and impaired tubulogenesis via p38 activation. Neutrophil-derived histones exerted similar effects. In vivo blood vessel formation in the quail chorioallantoic membrane was also reduced by H2B, H3 and H4. Their cytotoxic and antiangiogenic effects were suppressed by unfractioned and low-molecular-weight heparins and the combination of TLR2 and TLR4 blocking antibodies.

CONCLUSIONS

Histones trigger both apoptosis and pyroptosis of ECFCs and inhibit their angiogenic functions. Their cytotoxic and antiangiogenic effects are similar in mature endothelial cells and disappear after heparin addition or TLR2/TLR4 blockade, suggesting both as therapeutic strategies to improve tissue regeneration.

In-silico analyses of natural products on leishmania enzyme targets

Natural products are compounds that are isolated from plants, provide a variety of lead structures for the development of new drugs by the pharmaceutical industry. The interest in these substances increases because of their beneficial effects on human health, which include antiviral, antiallergic, antiplatelet, anti-inflammatory, antitumor, antioxidant, and antiparasitic activities. Leishmaniasis is the infection caused by protozoa of the genus Leishmania, which affects mainly people who live in poor countries, and can cause chronic fever, liver problems, anemia, and other blood problems. Current chemotherapies against the disease cause side effects, and are ineffective. There are no vaccines, and new chemotherapeutic agents for the treatment of leishmaniasis are greatly needed. This work reports on some of the enzymatic targets studied in the development of new drugs using natural products as inhibitors for the treatment of leishmaniasis. We applied ligand-based-virtual screening using Random Forest, associated with structure-based-virtual screening (docking), of a small dataset of 683 flavonoids and derivatives from an in-house data bank to select structures with potential inhibitory activity against pyruvate kinase, an important enzyme in Leishmania mexicana's energy production chemistry. The computer-aided drug design studies revealed good results against Leishmaniasis for flavones.

Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis

BACKGROUND

Alcohol is a risk factor for cancer of the oral cavity, pharynx, oesophagus, colorectum, liver, larynx and female breast, whereas its impact on other cancers remains controversial.

METHODS

We investigated the effect of alcohol on 23 cancer types through a meta-analytic approach. We used dose-response meta-regression models and investigated potential sources of heterogeneity.

RESULTS

A total of 572 studies, including 486 538 cancer cases, were identified. Relative risks (RRs) for heavy drinkers compared with nondrinkers and occasional drinkers were 5.13 for oral and pharyngeal cancer, 4.95 for oesophageal squamous cell carcinoma, 1.44 for colorectal, 2.65 for laryngeal and 1.61 for breast cancer; for those neoplasms there was a clear dose-risk relationship. Heavy drinkers also had a significantly higher risk of cancer of the stomach (RR 1.21), liver (2.07), gallbladder (2.64), pancreas (1.19) and lung (1.15). There was indication of a positive association between alcohol consumption and risk of melanoma and prostate cancer. Alcohol consumption and risk of Hodgkin's and Non-Hodgkin's lymphomas were inversely associated.

CONCLUSIONS

Alcohol increases risk of cancer of oral cavity and pharynx, oesophagus, colorectum, liver, larynx and female breast. There is accumulating evidence that alcohol drinking is associated with some other cancers such as pancreas and prostate cancer and melanoma.

The influence of emotional stress on Doppler-derived aortic peak velocity in boxer dogs

Background

Subaortic stenosis (SAS) is a common congenital heart disease in Boxers. Doppler‐derived aortic peak velocity (AoPV) is a diagnostic criterion for the disease.

Objectives

To investigate the influence of emotional stress during echocardiographic examination on AoPV in normal and SAS‐affected Boxers. To evaluate the effects of aortic root diameters on AoPV in normal Boxers.

Dogs

Two hundred and fifteen normal and 19 SAS‐affected Boxers.

Methods

The AoPV was recorded at the beginning of echocardiographic examination (T0), and when the emotional stress of the dog was assumed to decrease based on behavioral parameters and heart rate (T1). AoPV0–AoPV1 was calculated. In normal dogs, stroke volume index was calculated at T0 and T1. Aortic root diameters were measured and their relationship with AoPV and AoPV0–AoPV1 was evaluated.

Results

In normal dogs, AoPV was higher at T0 (median, 1.95 m/s; range, 1.60–2.50 m/s) than at T1 (median, 1.76 m/s; range, 1.40–2.20 m/s; P < .0001; reduction 9.2%). The stroke volume index at T0 also was greater than at T1 (P < .0001). Weak negative correlations were detected between aortic root size and aortic velocities. In SAS‐affected dogs, AoPV0 was higher than AoPV1 (P < .0001; reduction 7.3%).

Conclusion and Clinical Importance

Aortic peak velocity was affected by emotional stress during echocardiographic examination both in SAS‐affected and normal Boxers. In normal Boxers, aortic root size weakly affected AoPVs, but did not affect AoPV0–AoPV1. Stroke volume seems to play a major role in stress‐related AoPV increases in normal Boxers. Emotional stress should be taken into account when screening for SAS in the Boxer breed.

Acute abdominal aortic thrombosis caused by paroxysmal atrial fibrillation

Acute abdominal aortic thrombosis is a rare and potential fatal event, which occurs in adult subjects. We present the case of a 72-year-old-man, who referred to the emergency Department of our hospital because of persistent severe abdominal and perineal pain. Doppler ultrasounds and computerized tomography angiography revealed the acute thrombosis of the abdominal aorta. Immediate revascularization through aortic thrombo-endoarterectomy resolved the disease.

A meta-analysis of alcohol consumption and the risk of brain tumours

BACKGROUND

Alcohol is capable of traversing the blood-brain barrier and is thus a possible risk factor for brain cancer. Several epidemiological studies have been published on the issue, a number of those during recent years, with inconsistent findings.

MATERIALS AND METHODS

We performed a systematic literature search in the Medline and EMBASE databases. We found a total of 19 studies providing risk estimates for total alcohol or specific alcoholic beverages. Pooled estimates of the relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects models.

RESULTS

The pooled RR of brain cancer for alcohol drinkers versus non-drinkers was 0.97 (95% CI 0.82-1.15; based on 12 studies). Moderate (<2 drinks/day) and heavy alcohol drinkers had RRs of 1.01 (95% CI 0.81-1.25) and 1.35 (95% CI 0.85-2.15), respectively. With reference to specific alcoholic beverages, the RRs were 1.01 (95% CI 0.70-1.48) for wine, 0.96 (95% CI 0.82-1.12) for beer, and 1.20 (95% CI 1.01-1.42) for spirit consumption. The RRs for drinkers versus non-drinkers were 0.93 (95% CI 0.81-1.07) for glioma and 0.71 (95% CI 0.45-1.12) for meningioma.

CONCLUSIONS

Alcohol drinking does not appear to be associated with adult brain cancer, though a potential effect of high doses deserves further study.

Light alcohol drinking and cancer: a meta-analysis

BACKGROUND

There is convincing evidence that alcohol consumption increases the risk of cancer of the colorectum, breast, larynx, liver, esophagus, oral cavity and pharynx. Most of the data derive from studies that focused on the effect of moderate/high alcohol intakes, while little is known about light alcohol drinking (up to 1 drink/day).

PATIENTS AND METHODS

We evaluated the association between light drinking and cancer of the colorectum, breast, larynx, liver, esophagus, oral cavity and pharynx, through a meta-analytic approach. We searched epidemiological studies using PubMed, ISI Web of Science and EMBASE, published before December 2010.

RESULTS

We included 222 articles comprising ∼92 000 light drinkers and 60 000 non-drinkers with cancer. Light drinking was associated with the risk of oropharyngeal cancer [relative risk, RR = 1.17; 95% confidence interval (CI) 1.06-1.29], esophageal squamous cell carcinoma (SCC) (RR = 1.30; 95% CI 1.09-1.56) and female breast cancer (RR = 1.05; 95% CI 1.02-1.08). We estimated that ∼5000 deaths from oropharyngeal cancer, 24 000 from esophageal SCC and 5000 from breast cancer were attributable to light drinking in 2004 worldwide. No association was found for colorectum, liver and larynx tumors.

CONCLUSIONS

Light drinking increases the risk of cancer of oral cavity and pharynx, esophagus and female breast.

Differential role of EGF and BFGF in human GBM-TIC proliferation: relationship to EGFR-tyrosine kinase inhibitor sensibility

Glioblastoma multiforme (GBM) is among the most devastating human tumors being rapidly fatal despite aggressive surgery, radiation and chemotherapies. It is characterized by extensive dissemination of tumor cells within the brain that hinders complete surgical resection. GBM tumor initiating-cells (TICs) are a rare subpopulation of cells responsible for tumor development, growth, invasiveness and recurrence after chemotherapy. TICs from human GBM can be selected in vitro using the same conditions permissive for the growth of normal neural cells, of which share some features including marker expression, self-renewal capacity, long-term proliferation, and ability to differentiate into neuronal and glial cells. EGFR overexpression and its constitutive activation is one of the most important signaling alteration identified in GBM, and its pharmacological targeting represents an attractive therapeutic goal. We previously demonstrated that human GBM TICs have different sensitivity to the EGFR kinase inhibitors erlotinib and gefitinib, depending on the differential modulation of downstream signaling cascades. In this work we investigated the mechanisms of resistance to erlotinib in two human GBM TIC cultures, analyzing EGF and bFGF individual contribution to proliferation, clonogenicity, and migration. We demonstrated the presence of a small cell subpopulation whose proliferation is supported by EGF and a larger one mainly dependent on bFGF. Thus, insensitivity to EGFR kinase inhibitors as far as TIC proliferation results from a predominant FGFR activation that hides the inhibitory effects induced on EGFR signaling. Conversely, EGF and bFGF induced cell migration with similar efficacy. In addition, unlike neural stem/progenitors cells, the removal of chondroitin sulphate proteoglycans from cell surface was unable to discern EGF- and bFGF-dependent subpopulations in GBM TICs.

Alcohol drinking and non-Hodgkin lymphoma risk: a systematic review and a meta-analysis

BACKGROUND

Whether an association between alcohol drinking and non-Hodgkin lymphoma (NHL) risk exists is an open question. In order to provide quantification of the issue, we carried out a meta-analysis of published data.

METHODS

We identified 21 case-control and 8 cohort studies, including a total of 18,759 NHL cases. We derived meta-analytic estimates using random-effects models, taking into account correlation between estimates.

RESULTS

The overall relative risk (RR) of NHL for drinkers versus non-drinkers was 0.85 [95% confidence interval (CI) 0.79-0.91]. Compared with non-drinkers, the pooled RRs were 0.88 for light (≤1 drink per day), 0.87 for moderate (1 to <4 drinks per day), and 0.84 for heavy (≥4 drinks per day) alcohol drinking. There was no association for light drinkers in cohort studies, whereas for moderate and heavy drinkers, the RRs were similar in case-control (0.85 for moderate, 0.92 for heavy) and cohort (0.89 for moderate, 0.79 for heavy) studies. The inverse relation with alcohol consumption (drinkers versus non-drinkers) was similar in men (RR = 0.83) and women (RR = 0.86), but apparently stronger in studies from Asia (RR = 0.69) than other world areas (RR = 0.88).

CONCLUSION

This meta-analysis provides quantitative evidence of a favourable role of alcohol drinking on NHL risk, though the lack of a biological explanation suggests caution in the interpretation of results.

Alcohol drinking and risk of renal cell carcinoma: results of a meta-analysis

BACKGROUND

The role of alcohol consumption in relation with renal cell carcinoma is still unclear; a few studies have reported a beneficial effect of moderate levels of alcohol consumption, whereas it remains still under debate whether there is a dose-response association.

MATERIALS AND METHODS

Twenty observational studies (4 cohort, 1 pooled and 15 case-control) reporting results on at least three levels of alcohol consumption were selected through a combined search with PubMed and EMBASE of articles published before November 2010. Overall relative risks (RRs) and 95% confidence intervals (CIs) were estimated using random-effects models, and both second-order fractional polynomials and random effect meta-regression models were implemented for the study of dose-risk relation.

RESULTS

The estimated RRs were 0.85 (95% CI: 0.80-0.92) for any alcohol drinking, 0.90 (95% CI: 0.83-0.97) for light drinking (0.01-12.49 g/day), 0.79 (95% CI: 0.71-0.88) for moderate drinking (12.5-49.9 g/day) and 0.89 (95% CI: 0.58-1.39) for heavy drinking (≥50 g/day), respectively.

CONCLUSION

Our meta-analysis supports the hypothesis of a negative effect of moderate alcohol consumption on the risk of renal cell cancer.

ADMA, SDMA, L-Arginine and nitric oxide in allergic pediatric bronchial asthma

Published data regarding asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), L-arginine (L-ARG) and nitric oxide fraction in exhaled air (FeNO) in pediatric bronchial asthma are limited. Many question remain open about plasma concentration of these substances. The aim of this study is to evaluate ADMA, SDMA, L-ARG and FeNO concentration in allergic pediatric mild asthmatic patients in respect to healthy subjects. In this case-control study 60 children (50 asthmatics and 10 healthy) underwent a complete clinical visit, baseline respiratory function, allergy tests and biochemical analyses. The statistical significance of the different concentrations between the two groups were studied using one-way analysis of variance (ANOVA). A p value less than 0.05 was considered statistically significant. The mean plasma ADMA (0.58 vs 0.68 micromol/L), SDMA (0.40 vs 0.45 micromol/L) and L-ARG (52.2 vs 74.13 micromol/L) concentration were significantly lower (p less than 0.001) in the asthmatic patients in respect to healthy subjects (control group). The concentration of FeNO was significantly higher in the asthmatic subjects in respect to the control group (9.18 vs 4.2 micromol/L; p less than 0.001). Low plasma concentrations of ADMA, SDMA, L-ARG and high concentration of FeNO are associated with bronchial asthma and indicate an important role in airway disease through NO metabolism.

A meta-analysis on alcohol drinking and gastric cancer risk

BACKGROUND

Whether an association between alcohol drinking and gastric cancer risk exists is an open question. In order to provide a definite quantification of the association between alcohol drinking and gastric cancer risk, we conducted a meta-analysis of available data.

PATIENTS AND METHODS

We carried out a PubMed search of articles published up to June 2010 and identified 44 case-control and 15 cohort studies, including a total of 34 557 gastric cancer cases. We derived meta-analytic estimates using random-effects models, taking into account correlation between estimates. We carried out a dose-risk analysis using nonlinear random-effects meta-regression models.

RESULTS

Compared with nondrinkers, the pooled relative risk (RR) was 1.07 [95% confidence interval (CI) 1.01-1.13] for alcohol drinkers and 1.20 (95% CI 1.01-1.44) for heavy alcohol drinkers (≥4 drinks per day). The pooled estimates were apparently higher for gastric noncardia (RR for heavy drinkers=1.17, 95% CI 0.78-1.75) than for gastric cardia (RR=0.99, 95% CI 0.67-1.47) adenocarcinoma. The dose-risk model estimated a RR of 0.95 (95% CI 0.91-0.99) for 10 g/day and 1.14 (95% CI 1.08-1.21) for 50 g/day.

CONCLUSIONS

This meta-analysis provides definite evidence of a lack of association between moderate alcohol drinking and gastric cancer risk. There was, however, a positive association with heavy alcohol drinking.

Left ventricular noncompaction cardiomyopathy

Isolated left ventricular noncompaction (ILVNC) is a congenital abnormality in the structure of ventricular tissue due to amorphogenetic defect during embryogenesis. This rare entity can be easily diagnosed by the characteristic appearance of prominent trabeculations and deep inter-trabecular spaces. Clinical manifestations of this disease include benign and malignant ventricular arrhythmia, congestive heart failure signs, cardio-embolic events (stroke), mitral and pulmonary valve incompetence, and reduced global ventricular systolic function. We present the case report of a 58-year-old man with ILVNC.

Lycopene and preclinical carotid atherosclerosis

Evidence from epidemiological and clinical studies suggests a possible correlation between serum antioxidant levels and cardiovascular disease risk. High plasma concentrations of lycopene have been associated with reduced prevalence of cardiovascular disease. The aim of this study is to compare plasma concentrations of lycopene in subjects with or without ultrasonic evidence of asymptomatic carotid atherosclerosis. One hundred and twenty subjects underwent physical examination, ultrasonic measurement of common carotid artery intima-media thickness and serum profile analysis. Logistic regression methods and analysis of variance were used to determine whether differences existed between participants with or without evidence of carotid atherosclerosis. Of the 120 participants, 58 exhibited evidence of carotid atherosclerosis. Participants with ultrasonic evidence of carotid atherosclerosis exhibited significantly higher serum concentrations of total cholesterol, LDL-cholesterol and triglycerides. In contrast, participants with ultrasonic evidence of carotid atherosclerosis exhibited significantly lower plasma concentrations of lycopene. These data suggest that higher serum levels of lycopene may play a protective role versus cardiovascular diseases, in particular carotid atherosclerosis.

Recurrent atrial fibrillation in a patient with ulcerative colitis treated with azathioprine: case report and review of the literature

We present a clinical case report regarding recurrent atrial fibrillation in a patient with ulcerative colitis treated with azathioprine. Atrial fibrillation represents the most common sustained cardiac arrhythmia, occurring in 1-2% of the general population and characterized by seemingly disorganized atrial depolarizations without effective atrial contraction. Several mechanisms determine this arrhythmia; in particular remodelling (structural, mechanical and electrical alteration related to atrial fibrillation). The pro-arrhythmic effect of azathioprine may be evaluated during immunosuppressive therapy to be aware of this serious but reversible adverse effect.

A meta-analysis on alcohol drinking and esophageal and gastric cardia adenocarcinoma risk

BACKGROUND

In order to provide a precise quantification of the association between alcohol drinking and esophageal and gastric cardia adenocarcinoma risk, we conducted a meta-analysis of available data.

PATIENTS AND METHODS

We identified 20 case-control and 4 cohort studies, including a total of 5500 cases. We derived meta-analytic estimates using random-effects models, taking into account correlation between estimates, and we carried out a dose-risk analysis using nonlinear random-effects meta-regression models.

RESULTS

The relative risk (RR) for drinkers versus nondrinkers was 0.96 [95% confidence interval (CI) 0.85-1.09] overall, 0.87 (95% CI 0.74-1.01) for esophageal adenocarcinoma and 0.89 (95% CI 0.76-1.03) for gastric cardia adenocarcinoma. Compared with nondrinkers, the pooled RRs were 0.86 for light (≤ 1 drink per day), 0.90 for moderate (1 to < 4 drinks per day), and 1.16 for heavy (≥ 4 drinks per day) alcohol drinking. The dose-risk model found a minimum at 25 g/day, and the curve was < 1 up to 70 g/day.

CONCLUSIONS

This meta-analysis provides definite evidence of an absence of association between alcohol drinking and esophageal and gastric cardia adenocarcinoma risk, even at higher doses of consumption.

Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies

BACKGROUND

The International Agency for Research on Cancer (IARC) concluded that alcohol consumption is related to colorectal cancer (CRC). However, several issues remain unresolved, including quantification of the association for light (≤1 drink/day) and moderate (2-3 drinks/day) alcohol drinking, investigation of the dose-response relationship, and potential heterogeneity of effects by sex, colorectal site, and geographical region.

METHODS

Twenty-seven cohort and 34 case-control studies presenting results for at least three categories of alcohol intake were identified from a PubMed search of articles published before May 2010. The summary relative risks (RRs) were estimated by the random effects model. Second-order fractional polynomials and random effects meta-regression models were used for modeling the dose-risk relation.

RESULTS

The RRs were 1.21 [95% confidence interval (CI) 1.13-1.28] for moderate and 1.52 (95% CI 1.27-1.81) for heavy (≥4 drinks/day) alcohol drinking. The RR for moderate drinkers, compared with non-/occasional drinkers, was stronger for men (RR = 1.24, 95% CI 1.13-1.37) than for women (RR = 1.08, 95% CI 1.03-1.13; P(heterogeneity) = 0.02). For heavy drinkers, the association was stronger in Asian studies (RR = 1.81, 95% CI 1.33-2.46; P(heterogeneity) = 0.04). The dose-risk analysis estimated RRs of 1.07 (95% CI 1.04-1.10), 1.38 (95% CI 1.28-1.50), and 1.82 (95% CI 1.41-2.35) for 10, 50, and 100 g/day of alcohol, respectively.

CONCLUSIONS

This meta-analysis provides strong evidence for an association between alcohol drinking of >1 drink/day and colorectal cancer risk.

Relationship between asymmetric dimethylarginine and asymptomatic carotid atherosclerosis

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide (NO) associated with an increased risk of cardiovascular disease (CVD). In this study we assessed the relationship between ADMA and asymptomatic carotid intima-media thickness (CIMT). Eighty subjects underwent a complete history and physical examination, determination of serum chemistries and ADMA levels, and carotid ultrasound investigation (CUI). None of the subjects had symptoms of carotid atherosclerosis and nor were they taking any medication. Statistical analyses showed that high plasma levels of ADMA were positively correlated to CIMT (p less than 0.001). Total cholesterol, low density lipoprotein cholesterol, triglycerides and C-reactive protein plasma concentrations were significantly associated with asymptomatic carotid atherosclerosis (p less than 0.001). High serum concentrations of ADMA were associated with early carotid atherosclerotic lesions as measured by CIMT and represent a new marker of asymptomatic carotid atherosclerosis.

Circulating plasma antioxidants, inflammatory markers and asymptomatic carotid atherosclerosis in end-stage renal disease patients: a case control study

Few studies have been conducted on the relationship between antioxidant plasma vitamin concentrations, inflammatory markers and carotid atherosclerosis with inconclusive results in endstage renal disease (ESRD) patients. A case-control study was performed to investigate the relationship between plasma antioxidant concentrations, inflammatory markers, and carotid intima-media thickness (CIMT) in healthy subjects and in patients undergoing hemodialysis (HD). We enrolled 40 subjects (20 healthy, 20 with ESRD) asymptomatic for carotid atherosclerosis. After carotid ultrasound investigation (CUI), medical history data, physical examination, venous blood samples were collected. These were analyzed for concentrations of antioxidant vitamins (A, E), carotenoids (lycopene, beta-carotene), inflammatory markers (C-reactive protein, fibrinogen), and lipid profile. Low concentrations of vitamin A, vitamin E, lycopene, and beta-carotene were significantly associated with carotid atherosclerosis in patients with ESRD (p less than 0.001). In addition, high concentration of low density lipoprotein cholesterol and total cholesterol (p less than 0.01), C-reactive protein and fibrinogen (p less than 0.001) were also associated with carotid atherosclerosis, while other laboratory parameters considered (high density lipoprotein cholesterol and triglycerides) were not significantly associated with carotid atherosclerosis. A regular intake of foods rich in antioxidant vitamins with low fat concentrations may slow the progression of atherosclerotic process in this group of patients.

Doppler evaluation of maternal and fetal vessels during normal gestation in rabbits

The aim of this work was to evaluate the hemodynamic changes in the utero-placental arterial vessels in rabbits (Orictolagus cuniculus) throughout pregnancy as well as those in the umbilical cord, aorta, and caudal vena cava of fetuses to establish their normal reference ranges for systolic peak velocity (SPV), end diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI). The blood flow waveforms were monitored every 4 d in 10 rabbits from Day 10 of pregnancy onward by means of color and pulsed wave Doppler ultrasonography using a 5.5-7.5 MHz microconvex transabdominal probe. The utero-placental blood flow was characterized by steep increases and decrease in the SPV with a slow diastolic wave and relatively high EDV, whereas that of the umbilical artery was discontinuous until Day 22 of pregnancy, when a diastolic waveform was also detectable. From Day 10 to 22 of pregnancy, the fetal aorta blood flow was discontinuous, but thereafter a diastolic peak was measurable. The blood flow of the fetal caudal vena cava was characterized by a systolic peak followed by a small diastolic peak. Throughout the gestation, the SPV and the EDV of maternal and fetal vessels increased (alpha<0.05), whereas the PI and the RI decreased (alpha<0.05), except for the utero-placental vessels. This work confirms that the rabbit could also be a valid experimental animal model to study, by Doppler ultrasonography, functional hemodynamic changes of the fetuses and placenta vessels in both normal and pathophysiologic conditions.

Does drinking pattern modify the effect of alcohol on the risk of coronary heart disease? Evidence from a meta-analysis

OBJECTIVE

To evaluate the strength of the evidence provided by epidemiological literature investigating drinking pattern as effect modifier of alcohol intake on the risk of coronary heart disease (CHD).

DESIGN

Meta-analysis of observational studies.

DATA SOURCES

Medline, citation tracking, from 1966 to 2006.

REVIEW METHODS

Original studies investigating the amount of alcohol intake, combined with the frequency of alcohol consumption and/or pattern of alcohol drinking affecting the risk of CHD were extracted. Among them, cohort and case-control studies reporting sufficient data to perform statistical analyses and using people who abstained from alcohol as the reference were included.

RESULTS

Six (4 cohort and 2 case-control) out of 118 studies reviewed met the inclusion criteria. Compared with those who abstained from alcohol, regular heavy drinkers and heavy irregular or binge drinkers showed significantly different pooled relative risks of 0.75 (95% confidence interval 0.64 to 0.89) and 1.10 (1.03 to 1.17) respectively. The dose-response relation between the amount of alcohol intake and CHD risk was significantly different in regular and irregular drinkers. A J-shaped curve, with nadir around 28 grams of alcohol per week, and last protective dose of 131 grams per week, was obtained including drinkers who consumed alcohol for 2 days a week or less. Conversely, in people who consumed alcohol for more than 2 days a week a significant protective effect was seen even when drinking high amounts of alcohol.

CONCLUSION

This meta-analysis suggests that binge and heavy irregular drinking modify the favourable effect of alcohol intake on the CHD risk. However, this conclusion should be taken with caution because of the small number of studies considered.

Artificial sweeteners and cancer risk in a network of case–control studies

BACKGROUND

The role of sweeteners on cancer risk has been widely debated over the last few decades. To provide additional information on saccharin and other sweeteners (mainly aspartame), we considered data from a large network of case-control studies.

METHODS

An integrated network of case-control studies has been conducted between 1991 and 2004 in Italy. Cases were 598 patients with incident, histologically confirmed cancers of the oral cavity and pharynx, 304 of the oesophagus, 1225 of the colon, 728 of the rectum, 460 of the larynx, 2569 of the breast, 1031 of the ovary, 1294 of the prostate and 767 of the kidney (renal cell carcinoma). Controls were 7028 patients (3301 men and 3727 women) admitted to the same hospitals as cases for acute, non-neoplastic disorders. Odds ratios (ORs), and the corresponding 95% confidence intervals (CIs), were derived by unconditional logistic regression models.

RESULTS

The ORs for consumption of saccharin were 0.83 (95% CI 0.30-2.29) for cancers of the oral cavity and pharynx, 1.58 (95% CI 0.59-4.25) for oesophageal, 0.95 (95% CI 0.67-1.35) for colon, 0.93 (95% CI 0.60-1.45) for rectal, 1.55 (95% CI 0.76-3.16) for laryngeal, 1.01 (95% CI 0.77-1.33) for breast, 0.46 (95% CI 0.29-0.74) for ovarian, 0.91 (95% CI 0.59-1.40) for prostate and 0.79 (95% CI 0.49-1.28) for kidney cancer. The ORs for consumption of other sweeteners, mainly aspartame, were 0.77 (95% CI 0.39-1.53) for cancers of the oral cavity and pharynx, 0.77 (95% CI 0.34-1.75) for oesophageal, 0.90 (95% CI 0.70-1.16) for colon, 0.71 (95% CI 0.50-1.02) for rectal, 1.62 (95% CI 0.84-3.14) for laryngeal, 0.80 (95% CI 0.65-0.97) for breast, 0.75 (95% CI 0.56-1.00) for ovarian, 1.23 (95% CI 0.86-1.76) for prostate and 1.03 (95% CI 0.73-1.46) for kidney cancer. A significant inverse trend in risk for increasing categories of total sweeteners was found for breast and ovarian cancer, and a direct one for laryngeal cancer.

CONCLUSION

The present work indicates a lack of association between saccharin, aspartame and other sweeteners and the risk of several common neoplasms.

Self-reported history of hypercholesterolaemia and gallstones and the risk of prostate cancer

BACKGROUND

Although prostate cancer is one of the most common male cancers, its aetiology-and particularly the role of comorbidity-remains poorly understood.

PATIENTS AND METHODS

Between 1991 and 2002, a case-control study on prostate cancer was conducted in Italy. This included 1294 men under the age of 75 years with incident, histologically confirmed prostate cancer, and 1451 controls, admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic diseases. The subjects' self-reported history of selected medical conditions was assessed through a structured and satisfactorily reproducible questionnaire. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were obtained after allowance for major potential confounding factors.

RESULTS

A significant direct relation was observed between hypercholesterolaemia and prostate cancer (OR = 1.51, 95% CI 1.23-1.85). This association was stronger (OR = 1.80) in older subjects (age > or =65) than in younger ones (OR = 1.32). A non-significant excess risk of prostate cancer was also observed for gallstones (OR = 1.26, 95% CI 0.93-1.70) and the relation was apparently stronger in patients with lower body mass index (OR = 1.59).

CONCLUSIONS

This study suggests a possible relation between hypercholesterolaemia and prostate cancer.

Combined mortality and morbidity of direct surgical treatment of abdominal aortic aneurysm

Two hundred aneurysms of the abdominal aorta were treated surgically from 1980 to 1987 by the same surgeon. There were 187 men and 13 women whose mean age was 66.1 years. Nine patients were 80-years-old or more. Eighty-seven percent of patients had preoperative risk factors, 30% of which were coronary artery disease. The operative approach was through a transverse laparotomy in 188 patients compared to 11 midline incisions and one lumbotomy. An aortoaortic tube was inserted in 87 patients, a bifurcated prosthesis in 99, and a tube bypass in 14. Five patients (2.5%) died within the 30 day perioperative period. Death was due to colonic necrosis, right heart chamber thrombosis, renal failure after repeat operation for acute lower limb ischemia, and myocardial infarction associated with renal and respiratory failure. The morbidity rate was 15.7% (31 patients) and included seven neurologic accidents, four respiratory complications, five ischemic events of the lower limbs requiring reoperation and one amputation, four cardiac complications, two renal failures, one reversible colonic ischemia, one revision for incomplete hemostasis, one phlebitis, one sliding syndrome, and five minor infections or cutaneous complications. Mean duration of hospital stay was 10.9 days. These results confirm that direct operation on aortic aneurysms can be performed in patients from all age groups and even with associated diseases. A rapid, simple technique based on a transverse approach, minimal dissection and insertion of aortoaortic tubes, whenever feasible, appears to reduce combined mortality-morbidity.

[Congenital multiple arthrogryposis. Report of a case]

Six patients affected by arthrogriposis multiplex congenita (AMC) are studied and the detected alterations, the adopted treatment and the obtained results are described and discussed. Notwithstanding the limited number of considered cases, it is underlined that a precocious, constant and protracted treatment can considerably help these patients to gain a certain degree of self-sufficiency though it can not heal serious deformations. This result is also supported by the cases published by the literature.

Infantile seborrheic dermatitis: seven-year follow-up and some prognostic criteria

Based on clinical features, infantile seborrheic dermatitis (ISD) can be classified as follows: true seborrheic dermatitis (SD), psoriasiform seborrheic dermatitis (Psor SD), and erythrodermic seborrheic dermatitis. We reviewed the records of 72 children who had been affected by ISD several years earlier to investigate the evolution of disease, to evaluate the patients for the presence of new skin lesions, and to study family histories with respect to these conditions. In addition, we attempted to determine if there is any connection among the initial features of ISD and the types of skin lesions, and atopy or psoriasis. On reexamination, our patients previously diagnosed as having SD showed a larger variety of new skin lesions than those who had Psor SD, and 15% had developed atopic dermatitis. Atopic dermatitis was not present at follow-up in the children with previously diagnosed Psor SD. Psoriatic lesions were present in similar percentages in both groups at the time of reevaluation. Investigation of family history was not useful in predicting later development of psoriasis or atopic dermatitis. We conclude that the initial clinical features of ISD may be of prognostic value, and that SD and Psor SD are probably two different clinical entities.