Evaluation of Metabolic and Cardiovascular Risk Measured by Laboratory Biomarkers and Cardiopulmonary Exercise Test in Children and Adolescents Recovered from Brain Tumors: The CARMEP Study

In recent decades, the improvement of treatments and the adoption of therapeutic protocols of international cooperation has led to an improvement in the survival of children affected by brain tumors. However, in parallel with the increase in survival, long-term side effects related to treatments have been observed over time, including the activation of chronic inflammatory processes and metabolic alterations, which can facilitate the onset of metabolic syndrome and increased cardiovascular risk. The aim of this study was to find possible statistically significant differences in the serum concentrations of early biomarkers of metabolic syndrome and in the results of cardiopulmonary exercise testing between survivors of childhood brain tumors and healthy controls. This is a prospective and observational study conducted on a group of 14 male patients who survived childhood brain tumors compared with the same number of healthy controls. The concentrations of early metabolic syndrome biomarkers [adiponectin, leptin, TNF-α, IL-1, IL-6, IL-10, endothelin-1, apolipoprotein B, and lipoprotein (a)] were measured and a cardiopulmonary exercise test (CPET) was performed. Results: Childhood brain tumor survivors performed worse on average than controls on the CPET. Furthermore, they showed higher endothelin-1 values than controls (p = 0.025). The CPET results showed an inverse correlation with leptin. The differences found highlight the greater cardiovascular risk of brain tumor survivors, and radiotherapy could be implicated in the genesis of this greater cardiovascular risk.

Congenital coronary artery anomalies in sports medicine. Why to know them

The anomalous origin of a coronary artery (AOCA) is a challenging topic, due to its rarity, the complexity of the pathophysiological aspects, the clinical presentation (often silent), the difficulty of diagnosis, and the potential risk of causing acute cardiovascular events up to sudden cardiac death, particularly when triggered by heavy physical exercise or sport practice. Increasing interest in sport medical literature is being given to this topic. This paper reviews current knowledge of AOCAs in the specific context of the athletic setting addressing epidemiological and pathophysiological aspects, diagnostic work-up, sports participation, individual risk assessment, therapeutic options, and return to play decision after surgery.

Overcome the limits of multi-contaminated industrial soils bioremediation: Insights from a multi-disciplinary study

Phytoremediation can be a promising and sustainable strategy to recovery Potentially Toxic Elements (PTEs) contaminated soils. However, at the field level, this tool can be limited by many issues. Herein, we combined native plant species with different cover type (mono and poly culture) in an in-field mesocosm experiment for the remediation of multi-contaminated soils from Bagnoli brownfield site (Southern Italy). We preliminary gain insights about the physical, chemical and biological features of the soils and subsequently induced a potential variation in the soil microbiome. We found that polyculture better respond both in terms of pollutant phytostabilization efficiency and from a stress tolerance perspective. Among plant species, Festuca achieved the best performance due to the overexpression of metal transporters able in both PTEs influx and sequestration from the cytoplasm. We achieved a site-specific bio-factory, which represents a strategy for the sustainable and relatively fast recovery of large contaminated areas.

A-80 Global Neuropsychological Assessment (GNA): Preliminary Evidence of Clinical Utility

Objective

The Global Neuropsychological Assessment (GNA) is an 18-minute cognitive test battery with seven subtests that is being translated into multiple languages and standardized worldwide. This study seeks to evaluate the GNA’s ability to discriminate patients from healthy controls.

Data Selection

We are recruiting adults who are referred to the Johns Hopkins Medical Psychology Clinic for neuropsychological assessment, along with caregivers or family members who accompany them for this ongoing study. We have administered the GNA to 10 patients with mild cognitive impairment or another disorder and 22 healthy controls to date.

Data Synthesis

Patients and healthy controls did not differ on age, sex, or years of education.Independent samples t-tests showed that patients performed worse than healthy controls (p < 0.05) on 14 measures derived from five of seven GNA subtests. These included measures of episodic memory, processing speed, semantic verbal fluency, set-switching, and spatial working memory. Cohen’s d effect sizes of 1.0 to 2.2 were observed. The groups did not differ on tests of digit repetition or an anxiety/depression screener (Patient Health Questionnaire-4) although these revealed small to medium group differences (Cohen’s ds = 0.27 to 0.71) as well.

Conclusions

Five of seven GNA subtests effectively discriminated controls from patients with mixed cognitive disorders. If effect sizes found for the other two GNA subtests persist, they also will show significant group differences as the sample sizes increase. In related studies, we are examining inter-form equivalence and other psychometric properties of the GNA.

Investigation and Assessment for an effective approach to the reclamation of Polycyclic Aromatic Hydrocarbon (PAHs) contaminated site: SIN Bagnoli, Italy

Native plant species were screened for their remediation potential for the removal of Polycyclic Aromatic Hydrocarbons (PAHs) contaminated soil of Bagnoli brownfield site (Southern Italy). Soils at this site contain all of the PAHs congeners at concentration levels well above the contamination threshold limits established by Italian environmental legislation for residential/recreational land use, which represent the remediation target. The concentration of 13 High Molecular Weight Polycyclic Aromatic Hydrocarbons in soil rhizosphere, plants roots and plants leaves was assessed in order to evaluate native plants suitability for a gentle remediation of the study area. Analysis of soil microorganisms are provides important knowledge about bioremediation approach. Alphaproteobacteria, Betaproteobacteria, Gammaproteobacteria are the main phyla of bacteria observed in polluted soil. Functional metagenomics showed changes in dioxygenases, laccase, protocatechuate, and benzoate-degrading enzyme genes. Indolacetic acid production, siderophores release, exopolysaccharides production and ammonia production are the key for the selection of the rhizosphere bacterial population. Our data demonstrated that the natural plant-bacteria partnership is the best strategy for the remediation of a PAHs-contaminated soil.

Identification of native-metal tolerant plant species in situ: Environmental implications and functional traits

A study was undertaken to identify suitable native plants for the phytoremediation of the second largest integrated steelworks in Italy (Bagnoli brownfield site). A phytoecological survey allowed us to identify 139 plant taxa belonging to 58 different families. The most represented families were in the decreasing order Poaceae > Fabaceae > Asteraceae > Apiaceae. The biological spectrum showed a predominance of Therophytes > Hemycriptophytes > Phanerophyte. Seventy-six sites were selected on the presence of colonist's plants and vegetation assemblage patterns. At each site, roots and leaves of the dominant plant and rhizosphere soils were sampled. Total content of metal(loid)s in soils and plant parts were determined. Agronomic soil parameters were studied. Anthropogenic sourced metal(loid)s were discriminated from geochemical ones, and plant metal(loid) accumulation and translocation efficiency were evaluated. The role of many native plant species in terms of TEs phytomanagement strategy was recognizable inside the investigated area. According to this survey of structural plant diversity, several combinations between plants and microorganisms are being further investigated to identify relevant biological system for the phytomanagement of this contaminated area.

Normal aging and cognition: the unacknowledged contribution of cerebrovascular risk factors

Despite the widespread assumption that cognitive decline is an inherent part of the normal aging process, research suggests that part of the variance in age-related cognitive decline is attributable to modifiable factors common in geriatric populations such as cerebrovascular risk factors. We completed a literature search using Science Citation Index and evaluated the most cited articles from the last 10 years to determine the extent to which investigations of normal aging and cognition account for the influence of cerebrovascular risk factors. We found that the majority of the most frequently cited literature does not adequately account for the contribution of cerebrovascular risk factors and therefore, it is possible that many conclusions about normal aging and cognition are flawed or incomplete. Further investigation of the role of cerebrovascular risk factors in age-related cognitive decline is imperative to more accurately understand the effect of aging on cognition.

A genetic algorithms' approach to the exploration of parameter space in mesoscopic multicellular tumour spheroid models

The design of accurate in silico cancer models capable of quantitatively predicting tumor growth is an important goal in cancer research today. Mesoscopic models have shown great promise in this scenario; however, their use is often inhibited by the difficulty in correctly assigning parameter values. In this paper, enabled by an extremely computationally efficient mesoscopic model, we propose a generic algorithms' (GAs) approach to the exploration of parameter space. Analysis of the results suggest that this novel application of GAs to tumor growth models both facilitates the attribution of parameter values to the fitting of experimental data and, more importantly, lends insight to the role played by the different parameters in regulating the tumor model growth.

Bridging the Gap between mesoscopic and macroscopic models: the case of multicellular tumor spheroids

Multicellular tumor spheroids are valuable experimental tools in cancer research. By introducing an intermediate model, we have been able to successfully relate mesoscopic and macroscopic descriptions of spheroid growth. Since these descriptions stem from completely different roots (cell dynamics, and energy conservation and scaling arguments, respectively), their consistency validates both approaches and allows us to establish a direct correspondence between parameters characterizing processes occurring at different scales. Our approach may find applications as an example of bridging the gap between models at different scale levels in other contexts.

[Comparative study of mandibular growth and rotation in two sample groups treated according to the "Distal Active Concept" or the Edgewise technique]

The "Distal Active Concept" therapy, favours an immediate repositioning of the mandible and introduces new therapeutic sequences which allow an easy correction of the Class II molar relationship, enhancing the mandibular growth simultaneously. The "Distal Active Concept" therapy is a combined treatment which induces the correction of the Class II malocclusion without extractions and without headgear. The dento-alveolar unit is used as a functional matrix to free, then enhance the mandibular growth and induce its counter-clockwise rotation. 35 patients treated with the "Distal Active Concept" therapy are compared to 33 patients, treated with the extraction of four bicuspids and in Edgewise therapy, in order to visualize the mandibular growth and the counterbalancing rotation described by Dibbets.

[Anthracyclines and the heart]

Cardiotoxicity is the most important side effect of the highly effective chemotherapeutic drugs anthracyclines. The total dose that must not be surpassed to avoid cardiotoxicity is specific for each anthracycline. For doxorubicin the maximal dose is 450-550 mg/mq. Nevertheless cardiotoxicity can be observed in some cases even with doses smaller than the critical ones. Clinical signs of cardiotoxic damage can appear at any stage during the course of therapy. The prevention of cardiac damage can be tried in three ways. Firstly one should extend the administration period of the total dose of the drug for about 6 hours. The second way is based on the use of anthracycline analogs less toxic and possibly equally effective than doxorubicin. Finally one can associate to the anthracycline a cardioprotective drug such as ICRF187. The diagnosis of cardiotoxicity is usually reached evaluating the reduction of left ventricular ejection fraction either with echocardiography or with angiocardiography. Other parameters, particularly those evaluating the diastolic function, are under study to make the diagnosis more quick and accurate. Both cardiac scintigraphy and tomography also seem to offer promising tools for the diagnosis of anthracycline cardiotoxicity. Endomyocardiac biopsy is highly effective for the diagnosis, but is indicated only for selected cases. The therapy of anthracycline cardiomyopathy is directed mainly to the control of congestive heart failure. In the initial phase the treatment is based on the use of digitalis and diuretics, that are substituted in the following maintaining phase by ACE inhibitors.

Tracheal aspirates in long-term mechanically ventilated patients. A human model of gram-negative infection and airway inflammation

It is well known that patients requiring long-term mechanical ventilation and tracheostomy have nearly universal airway colonization with Gram-negative organisms. However, useful parameters to objectively describe the airway inflammation associated with airway instrumentation and colonization have not been well define. In our respiratory care unit, patients who are medically stable except for ventilator dependence are readily available for longitudinal assessment of airway secretions and therefore provide a unique population for studying airway inflammation and infection. To quantitate production of respiratory secretions, we instituted a uniform protocol of suctioning over a 6-h period. Further, we devised a method of dilution and homogenization of tracheal aspirates that permits reproducible intrasample total cell counts (coefficient of variation, 4.6%). With these techniques, patients were then studied serially over a 4- to 7-week period. Total cell count, inflammatory cell differential, and two indices of airway inflammation, human neutrophil elastase (HLE) and soluble-intercellular adhesion molecule-1 (sICAM-1) studied in the sol phase of secretions were monitored. The mean total cell count was 42.2 x 10(6) cells per gram of secretions when patients were clinically stable and not receiving antibiotics. The average differential was neutrophils 69.9%, macrophages 26.9%, and lymphocytes 2.8%. Mean active HLE was 35.6 micrograms/mL and mean sICAM-1 was 83 ng/mL. Six patients during the period of observation received intravenous oral or aerosolized antibiotics for tracheobronchitis. A threefold drop in volume of secretions was measured (p < 0.018). The total cell count and percent neutrophils decreased from 76.4 x 10(6)/g of sputum to 54.9 x 10(6) and 72.2 to 54.9%, respectively. While these changes were not statistically significant, the absolute number of airway neutrophils over the 6 h decreased sevenfold (p < 0.014). Similarly sICAM-1 burden (micrograms per 6-h period) also decreased significantly (p < 0.034). These patients provide a unique human model for future studies specifically designed to assess the effect of novel modalities of anti-inflammatory and antimicrobial agents on respiratory secretions.

Albuterol delivery in a model of mechanical ventilation. Comparison of metered-dose inhaler and nebulizer efficiency

Using an in vitro model, we compared efficiencies of jet nebulizers and metered-dose inhalers (MDI) with actuator devices to deliver albuterol in various conditions of mechanical ventilation. Factors tested included influence of humidification, MDI actuator device (Aerovent spacer or Marquest 172275 MDI adaptor), and synchronization of MDI to the respiratory cycle. With the nebulizer (AeroTech II) filled with 2.5 mg albuterol sulfate in 3 ml water and run until dry, inhaled mass was 42 +/- 2.6% and mass median aerodynamic diameter (MMAD) was 1.3 microns on a nonhumidified circuit. With the MDI+ Aerovent, the inhaled mass percentage per 90 microgm puff was 15.4 +/- 0.2% with humidification and 25.1 +/- 3.7% without humidification, actuations being synchronized with the beginning of inspiration and separated by a 1-min pause. Failure to synchronize actuations with inspiration or to pause 1 min resulted in significant reductions in inhaled mass (by 35 and 72%, respectively). The Marquest adaptor was less efficient, with an inhaled mass of 7.2 +/- 0.7% under optimal conditions. Metered-dose inhaler actuation during expiration resulted in relatively large particles (MMAD = 2.0 microns). All other MDI actuations led to essentially biphasic distributions, with particles greater than 1 micron following a distribution similar to the nebulizer and the overall MMAD estimated to be 0.22 microns. The AeroTech II delivered a cumulative 1,000 micrograms of drug (2,500 x 0.40) over 40 min. To achieve that amount, the MDI connected to the Aerovent and used in its most efficient sequence would require 45 timed puffs (90 micrograms per puff, 25.1% mean inhaled mass) and take 45 min of an experienced therapist's time.(ABSTRACT TRUNCATED AT 250 WORDS)

T lymphocyte subsets in chronic uremic patients treated with maintenance hemodialysis

Blood T lymphocyte subsets have been studied using monoclonal antibodies in 10 chronic uremic patients treated with maintenance hemodialysis. Both total T lymphocytes identified by the antibody OKT3, and the helper-inducer T lymphocyte subset identified by the antibody OKT4 were found to be significantly lower than normal. The cytotoxic-suppressor T cell subset was only moderately, even if significantly reduced, so that the T4/T8 ratio in uremic patients was significantly lower than normal. These data provide an additional contribution to the interpretation of immunological and hematological deficiencies observed in chronic uremia.

Defective burst-promoting activity of T lymphocytes from anemic and nonanemic elderly people

Erythroid stem cell proliferation is regulated by lymphokines and erythropoietin. The helper subset of T lymphocytes is known to produce the erythroid growth factor IL-3 or burst-promoting activity (BPA), while the suppressor subset seems to inhibit the erythroid growth. Leukocyte-conditioned media derived from white cells of nonanemic elderly were reported to provide defective support to the erythropoiesis. In two groups of elderly, nonanemic and anemic, we studied the ability of T lymphocytes to stimulate the BFU-E growth and the in vitro effect of cimetidine, as a drug that inhibits the suppressor T lymphocytes. Culture data were then compared with the peripheral blood lymphocyte picture. The study shows that defective mononuclear cell support to the BFU-E growth, namely due to reduced absolute number of the T4 subset of T lymphocytes, can be observed in both anemic and nonanemic elderly. It is suggested that isolated defective BPA production is not always sufficient to induce anemia. In most cases, anemia of unexplained origin in senescence would be due to the concomitance of both BFU-E impairment and defective BPA production. The simultaneous evaluation of BFU-E growth, lymphokine production, and the T-lymphocyte blood picture offers the best way to investigate the erythropoiesis of the elderly.

[Question of differential diagnosis in a case of chronic B-cell lymphopathy]

We have reported the case of a woman aged 76 years suffering from pancytopenia, splenomegaly, relative lymphocytosis, lymphocytes with villous projection in the peripheral blood. On the basis of membrane phenotype, cytochemistry, ultrastructural examination of blood and marrow lymphocytes, differential diagnosis was between chronic lymphatic leukemia (CLL), CLL of mixed cell type, hairy cell leukemia (HCL), HCL variant, splenic lymphoma with circulating villous lymphocytes (SLVL), Non-Hodgkin lymphoma of mantle zone (NHL). The application of morphologic and immunological methods has reinforced the value of cytomorphology and has proved advantageous in increasing our understanding of the heterogeneity of B CLL itself. A new classification of chronic B leukemias has been proposed on the basis of clinical, cytomorphological, histological, cytochemical, immunological criteria: CLL; CLL of mixed cell type including cases with more than 10% and less than 55% prolymphocytes (CLL/P) and a less well defined form with pleomorphic lymphocytes (CLL/P) and a less well defined form with pleomorphic lymphocytes but less than 10% prolymphocytes; prolymphocytic leukemia (PLL); hairy cell leukemia (HCL); HCL variant; splenic lymphoma with circulating villous lymphocytes (SLVL); leukemic phase of NHL (follicular lymphoma, intermediate or mantle zone lymphoma, and others); lymphoplasmacytic lymphoma; plasma cell leukemia. Even if the application of cytomorphological and immunological criteria has increased our knowledge of the heterogeneity of chronic B leukemias, in some cases, as in the one reported, exact classification may be very difficult. However, on the basis of clinical and laboratory criteria this case can be classified as SLVL, notwithstanding some discrepancies of the immunophenotype.

Defective in vitro growth of BFU-E of elderly subjects revealed by hydrocortisone

The effect of aging on hematopoiesis and bone marrow exhaustion have long been debated. Unexplained anemia and impaired in vitro proliferation of erythroid precursors is frequently observed in the elderly. As hydrocortisone is known to increase the BFU-E in vitro growth, we have studied the response of BFU-E to hydrocortisone in a group of nonanemic elderly subjects. The BFU-E growth in methylcellulose from blood mononuclear cells (MNC), stimulated by lymphocyte-conditioned medium (LCM), either with or without hydrocortisone, of 10 subjects aged 76-91 years was compared with the BFU-E growth from MNC of a group of ten young subjects. While LCM induced a significant increase of BFU-E growth, both in young and old subjects, hydrocortisone induced a significant increase of BFU-E growth only in young subjects. This study shows that in the elderly, there is a latent defect of erythropoiesis, possibly consisting of a defective ability to modulate the receptors for erythropoietin on BFU-E, and that hydrocortisone offers a useful tool to identify it.

[Recent findings on the pathogenesis and therapy of anemia in chronic kidney failure]

Recent studies showed that the blood BFU-E, when subtracted from the uremic milieu, normally responds to the stimulating factor produced by T lymphocytes. The serum of uremic patients inhibits the in vitro growth of normal BFU-E, however, the inhibition is almost completely reversed by hemodialysis. These data allow to understand why the therapy with erythropoietin relieves the anemia of CRF. Uremic T lymphocytes fail to stimulate the BFU-E growth. Normal T lymphocytes are inhibited by uremic serum and the hemodialysis does not correct the defect. Lymphopenia, decreased number of both T4 and T8 lymphocytes and low T4/T8 ratio were found in 50% of patients. Cimetidine was still able to increase the burst-stimulating activity of uremic T lymphocytes through inhibition of the suppressor T subset. In conclusion, one can say that in CRF T8 lymphocytes are normal and that uremic toxins decrease both number and function of T4 lymphocytes. The deficiency of BPA appears to significantly contribute to the pathogenesis of the anemia of CRF. The experience from our and other Institutions shows the effectiveness of the recombinant human erythropoietin in relieving the anemia of CRF, notwithstanding the hematological milieu is highly modified by uremia.

Effect of cimetidine on burst-promoting activity of normal T lymphocytes

The effect of cimetidine, an inhibitor of suppressor T lymphocytes, on the burst-promoting activity (BPA) of normal T lymphocytes has been studied. Cimetidine has been shown to increase the BPA of normal T lymphocytes, both when added to the culture and when T lymphocytes were preincubated for 1 h with it. Cimetidine had no direct effect on the in vitro growth of burst-forming units (BFU-E). Our results show that CD8 suppressor T lymphocytes inhibit the in vitro growth of BFU-E in normal conditions, either directly or through inhibition of BPA of CD4 helper T lymphocytes. Cimetidine has proved to be a useful tool for investigating the hematological role of T-lymphocyte subsets in normal and pathological conditions.

[Evaluation of antibody specificity of the monoclonal component in a case of Waldenström's macroglobulinemia]

The antibody specificity of the monoclonal component was studied in a patient with Waldenström's macroglobulinemia who presented with high values of antistreptolysin O (ASO) titer and protein C which are clinical unlikely. Our methods demonstrated that two tests were falsely positive, inasmuch as the antibody activity of the monoclonal component was directed towards the albumin plus latex complex which theoretically is an inert immunological substrate.

In vitro growth of erythroid progenitor cells (BFU-E) and production of burst-promoting activity (BPA) by T lymphocytes in patients with myelodysplastic syndromes

The in vitro growth of circulating erythroid progenitors (BFU-E) populations and the production of burst-promoting activity (BPA) by T lymphocytes have been studied in 17 patients with myelodysplastic syndromes. Based on the in vitro growth patterns of BFU-E, four groups of patients have been identified: i) normal BFU-E growth; ii) low spontaneous BFU-E growth, but normal response to LCM; iii) impaired BFU-E response to LCM; iv) no BFU-E growth. The pattern of BFU-E growth seems to be related to the clinical stage of the disease rather than to the FAB subgroup to which the patients belong. The ability of T lymphocytes to stimulate BFU-E growth was significantly reduced in all patients. The possible mechanisms inducing the impaired production of BPA by T lymphocytes are discussed. The in vitro evaluation of circulating erythroid precursors can supply useful prognostic information and possibly indications concerning the responsiveness of erythropoietic stem cells to recombinant human erythropoietin in vivo.

Effect of cimetidine on peripheral blood lymphocytes from chronic uremic patients: improvement of burst-promoting activity

We have studied the in vitro effect of cimetidine, an inhibitor of suppressor T lymphocytes, on T lymphocytes of 6 uremic subjects and on normal T lymphocytes preincubated with the serum from the same patients. Cimetidine has been shown to increase the burst-promoting activity (BPA) of uremic T lymphocytes and to partially improve the BPA of normal T lymphocytes preincubated with uremic serum. The present study shows that suppressor T lymphocytes are not affected by uremic inhibitors and that chronic uremia, besides inducing a decrease in the number of helper T lymphocytes, impairs their ability to stimulate the BFU-E in vitro growth.

Urine pentamidine as an indicator of lung pentamidine in patients receiving aerosol therapy

To determine if urine pentamidine was reflective of lung pentamidine, we compared levels of the drug in bronchoalveolar lavage fluid and simultaneously obtained urine. Thirty-one patients who were receiving aerosolized pentamidine either as treatment or as prophylaxis underwent BAL and submitted urine samples for pentamidine analysis. Pentamidine was analyzed in both phases of BAL fluid (supernatant and cell pellet) and in urine using high performance liquid chromatography. Urine results were normalized for creatinine. Patients were categorized as prophylaxis failures (active Pneumocystis carinii pneumonia on prophylaxis), electives (free from PCP on prophylaxis), treatment (daily AP in treatment doses for active PCP, or miscellaneous (single dose of AP). Levels in BAL fluid and urine varied widely over several orders of magnitude. However, for all patients, we found a highly significant relationship between BAL supernatant and urine (r = 0.97, p less than 0.0001). No statistical differences were found when comparing levels of pentamidine between failures and electives; however, the number of failures was small. We conclude that urine pentamidine is related to lung pentamidine and can be used as a clinical indicator in patients receiving aerosolized therapy.

Effect of corticosteroid treatment on hemopoiesis in vivo and in vitro in a patient with Felty's syndrome

We have studied the CFU-GM and BFU-E in vitro growth in a neutropenic and anemic patient with Felty's syndrome, either before or one and three months after steroid therapy when neutrophils and erythrocytes returned to normal. Both CFU-GM growth and CSA production were found to be low before therapy, and prednisone was shown to raise them to normal levels. The in vitro growth of BFU-E and the production of BPA by T lymphocytes of the patient were significantly lower than normal when studied before therapy. However, the T lymphocytes incubated in vitro with hydrocortisone regained their ability to stimulate the BFU-E growth. After prednisone therapy both BFU-E growth and BPA production by T lymphocytes returned to normal. Possible pathogenetic mechanisms of impaired granulo- and erythropoiesis in Felty's syndrome are discussed. The in vitro study with hydrocortisone can help to identify steroid-sensitive patients.

Inhibition of BFU-E in vitro growth and of burst-promoting activity of T lymphocytes by serum of chronic uremic patients receiving hemodialysis

The effects of uremic serum on the in vitro growth of normal BFU-E and on the burst-promoting activity by normal T-lymphocytes were evaluated separately. The effect of hemodialysis on the removal of possible serum inhibitor(s) was also tested. Sera of 12 uremic patients were shown to provoke a 60% inhibition of the in vitro growth of normal BFU-E and almost complete abolition of burst-promoting activity by T lymphocytes. While hemodialysis significantly removed the inhibition of uremic sera on BFU-E growth, it was rather ineffective in removing the inhibitor(s) of T lymphocytes. The different effects of uremic serum on BFU-E and on T lymphocytes are discussed.

Effect of hydrocortisone on BFU-E growth and on burst-promoting activity of T lymphocytes in man

Glucocorticosteroid hormones have been reported either to stimulate or to inhibit human erythropoiesis. We have studied the in vitro effect of hydrocortisone, 10(-6) mol/l, on human BFU-E when stimulated by preconstituted burst-promoting activity (BPA) in a medium conditioned by T lymphocytes. Hydrocortisone was found to stimulate BFU-E growth, even at largely suboptimal concentrations of BPA, through hormone receptors, as the effect was blocked by preincubation of BFU-E with equimolar progesterone. The possibility that glucocorticosteroids may increase the number and/or affinity of erythropoietin receptors on BFU-E is discussed. We have also studied the effect of hydrocortisone on the production of BPA by human T lymphocytes stimulated by phytohemagglutinin. Preincubation of T lymphocytes for 1 h with hydrocortisone, 10(-6) mol/l, significantly reduced the BPA of lymphocyte-conditioned medium. Again the inhibition of BPA production was reversed by incubation of lymphocytes with equimolar doses of progesterone. The conflicting results previously reported on the effect of glucocorticosteroids on erythropoiesis may be due in part to the opposing effects of the hormones on BFU-E growth and BPA production. The role hydrocortisone plays in the physiological regulation of human erythropoiesis is at present largely unknown.

[Transient loss of consciousness: a frequent and difficult problem in emergency service. Retrospective analysis of 391 cases]

The present study was designed to evaluate the patients with transient loss of consciousness who are seen in the emergency room and the ways in which they are currently triaged and evaluated, to determine the risk factors influencing their prognosis, and to analyze the aspects of diagnostic evaluation that are most useful. We made a retrospective study of 391 patients with transient loss of consciousness seen at the emergency room of S. Martino hospital. The causes of loss of consciousness, admission decision, diagnostic tests ordered, initial and final diagnoses and mortality are evaluated. The admission decision was influenced by three factors: cause of loss of consciousness, presence of chronic disease, and patient age. The same factors were shown to influence mortality. Full concordance between initial and final diagnosis was only 50 per cent. In 18.6 per cent of patients the cause of loss of consciousness was not identified at dismissal. The history and physical examination were crucial elements in the evaluation of most patients, and only in selected cases did tests such as electrocardiogram, Holter monitoring, electroencephalogram, computerized tomography scan provide diagnostic information.

Inadequate ability of T-lymphocytes from chronic uremic subjects to stimulate the in vitro growth of committed erythroid progenitors (BFU-E)

The growth of normal burst-forming units (BFU-E) is known to depend on a burst-promoting activity (BPA) produced by T-lymphocytes. Few BFU-E colonies have been observed in cultures of blood mononuclear cells (MNC) of uremic patients. The aim of the present study was to examine the concentration of BFU-E in the blood of uremic patients and to evaluate the ability of uremic T-lymphocytes to produce BPA. We have studied 6 chronic uremic patients treated with maintenance hemodialysis. When 5 X 10(5) blood MNC depleted of T-lymphocytes of uremic subjects were stimulated by 1 X 10(6) normal T-lymphocytes in a methylcellulose culture system we observed the growth of a number of BFU-E colonies that did not differ significantly from normal (29 +/- 11.8 colonies). On the contrary, when 5 X 10(5) blood MNC depleted of T-lymphocytes of normal subjects were stimulated by 1 X 10(6) T-lymphocytes of uremic patients, the number of BFU-E colonies obtained was significantly lower than normal (1.9 +/- 3.1 colonies). These data show that the decreased number of BFU-E colonies obtained from blood MNC of uremic patients is due to a defect of uremic T-lymphocytes. The impairment of T-lymphocytes can be due to inhibitors of T-lymphocyte function or to variations in T cell subsets, leading to a decrease in the OKT4/OKT8 cell ratio. In any case it is a significant pathogenetic mechanism contributing to anemia in chronic uremia.

Alterations of granulopoiesis in chronic uremic patients treated with intermittent hemodialysis

Granulocyte-macrophage progenitor cells (CFU-GM), leukocyte colony-stimulating activity (CSA), granuloblast differentiation and proliferation and the effect of uremic serum on the in vitro growth of normal CFU-GM have been studied in 8 chronic uremic patients treated with intermittent hemodialysis three times a week. The studies were performed in the postabsorptive state twice in each patient, that is at the longest and shortest dialytic interval. CFU-GM growth in agar and leukocyte CSA did not differ significantly from the normal level in uremic subjects. The granulocytic and macrophagic differentiation in a liquid culture system was significantly reduced in uremic patients, notwithstanding the appearance of high numbers of undifferentiated blastic cells. The serum of uremic patients had no effect on normal CFU-GM and leukocyte CSA.

Blood granulocyte-macrophage progenitor cell concentrations and differentiation in vitro in patients with hepatic cirrhosis

Blood granulocyte-macrophage progenitor cells (CFU-GM) and myeloid differentiation were studied in 16 patients with hepatic cirrhosis by culturing blood mononuclear cells in semisolid and in liquid medium. The numbers of CFU-GM from normal and cirrhotic subjects were not significantly different, even when increased numbers of monocyte-macrophagic colonies and decreased numbers of granulocytic colonies were observed in cirrhotic patients. Significantly reduced granulocytic growth and increased monocyte-macrophagic cell growth were found in liquid culture of cirrhotic patients. These data seem to indicate that in hepatic cirrhosis, besides granulocyte sequestration within the spleen, there is a disorder of granulocytic versus monocyte-macrophagic differentiation.

Comparison between diurnal changes and changes induced by hydrocortisone and epinephrine in circulating myeloid progenitor cells (CFU-GM) in man

A significant increase from 8 AM to 3 PM was found in both myeloid progenitor cell (CFU-GM) and polymorphonuclear leukocyte (PMN) blood concentration in 45 normal subjects. Diurnal blood (CFU-GM and PMN changes were significantly correlated. Spontaneous diurnal changes in blood CFU-GM levels and in PMN were compared with the changes induced by i. v. administration of hydrocortisone (16 normal volunteers) and of epinephrine (10 normal volunteers). Diurnal changes in CFU-GM and PMN seem to follow a pattern similar to that induced by epinephrine administration. These findings suggest that diurnal changes in CFU-GM reflect mainly a shift of these cells between different blood compartments.

Disorders of granulopoiesis in patients with untreated Graves' disease

Total and differential leucocyte countings, mobilization of the marrow granulocyte reserve with hydrocortisone and growth of blood colony-forming cells (CFU-C) in agar culture have been evaluated in 17 patients with Graves' disease before therapy. Moreover, the myeloid differentiation of blood CFU-C in liquid culture has been studied in 4 patients. Neutropenia was found in only 1 patient (5.9%), while the marrow granulocyte reserve was reduced in 7 out of 15 patients (46.7%). Blood concentration of CFU-C and myeloid differentiation in liquid culture were normal in all patients studied. These data show an abnormal granulopoiesis in a high percentage of patients with untreated Graves' disease. The mechanisms accounting for the reduction of the marrow granulocyte reserve in patients with Graves' disease are discussed.

Mobilization of colony-forming cells (CFU-C) into the peripheral blood of man by hydrocortisone

The effect of hydrocortisone on blood CFU-C has been studied in six normal subjects through a double layer agar culture system. Increased numbers of CFU-C appeared in the peripheral blood reaching a maximum 366% to 631% increase 5-8 hours after the i.v. administration of the hormone. Contemporary lymphopenia caused a 4 to 10 fold enrichment in the proportion of CFU-C to lymphocytes. Hydrocortisone added in vitro somewhat inhibited the colony growth. The results suggest that the increase of blood CFU-C is due to mobilization from the bone marrow. Hydrocortisone, when compared to other agents, appears to offer some advantages in increasing the blood CFU-C for clinical purposes.

[Surgical treatment of biliary lithiasis associated with acquired valvulopathy]

Personal experience in the treatment of acquired valvulopathies and biliary calculosis in one operating stage is reported. After examination the risk factors determining onset of bile calculosis in valvulopathic patients, the surgical techniques adopted and the special advantages obtained by associating the two operations at the same session are illustrated.

Influence of the spleen on the blood distribution of the colony-forming cells (CFU-C) in man

The incidence of the blood committed granulocyte progenitor cells (CFU-C) before and after epinephrine administration has been studied in 10 normal, 16 splenomegalic and 8 splenectomized subjects through a double-layer agar culture system. A significant increase of the mean values of CFU-C per milliliter of blood has been observed after epinephrine administration in normal and in splenomegalic subjects. In splenectomized patients the baseline mean values of CFU-C per milliliter of blood were higher than those observed in the other groups of subjects, but they did not increase after epinephrine infusion. The concentration of CFU-C per 10(6) total blood leukocytes was the same in all three groups of subjects and it was not modified by epinephrine administration. Our results seem to indicate that the CFU-C are distributed in two blood compartments, the spleen representing an important section of the marginal compartment of the blood CFU-C.

Influence of the spleen on the blood distribution of the leukocytes producing colony-stimulating activity (CSA) in man

The colony-stimulating activity (CSA) produced by the blood leukocytes has been studied before and after epinephrine administration in ten normal, 15 splenomegalic, and seven splenectomized subjects through a double layer agar culture system. A significant increase of mean values of the CSA per milliliter produced by blood monocytes has been observed after epinephrine administration in the groups of normal and of splenomegalic subjects. In the group of splenectomized subjects the baseline mean value of CSA per milliliter of blood was higher than those observed in the other groups, but it did not show any increase after epinephrine infusion. The CSA produced by 10(6) blood leukocytes was similar in all three groups of subjects, and it was not similarly modified by epinephrine administration. Our results seem to indicate that the leukocytes producing CSA are distributed within two rapidly exchangeable blood compartments, the spleen representing an important section of the marginal compartment of blood monocytes.

Normal range of blood colony-forming cells (CFU-C) in humans: influence of experimental conditions, age, sex, and diurnal variations

Blood colony-forming cells (CFU-C) and colony-stimulating activity obtained from feeder layers of peripheral blood leucocytes (leucocyte CSA) have been studies in 69 normal subjects by means of semisolid agar culture system. Groups of normal volunteers were selected according to sex and age (20 to 45 and older than 60 years) and the results compared. The mean number of circulating CFU-C was significantly lower in young women (20-45 years old) than in males over 60 years of age, but no differences were found among the other age and sex groups. Leucocyte CSA did not significantly differ among these groups. In 5 young males the blood CFU-C did not show significant variations at 8 AM and at 4 PM of the same day. When the study was repeated in 18 subjects at longer time intervals, the number of colonies showed a maximum fivefold variation. The amount of plasma and polymorphonuclear granulocytes present in our culture system did not inhibit the colony growth. In most cases, double layer cultures grow a higher number of colonies than single layer, but feeder layers of some normal subject seem to inhibit the colony growth.

Blood colony-forming cells (CFU-C) and leucocyte colony-stimulating activity (CSA) in patients with neutrophilic leucocytosis

The incidence of circulating colony-forming cells (CFU-C) and the ability of peripheral leucocytes to stimulate the colony formation (CSA) have been studied through a double layer agar culture system in 26 patients with neutrophilic leucocytosis and compared to the values obtained in 26 normal subjects. Both mean CFU-C incidence and mean leucocyte CSA of the whole group of patients were found significantly higher than normal, but considerable variation was observed among singular patients. The different patterns of blood CFU-C and leucocyte CSA are discussed. The combined evaluation of blood CFU-C and leucocyte CSA is found a useful tool to investigate the pathogenetic mechanisms of neutrophilic leucocytosis.