Self-reported adherence to diet and preferences towards type of meal plan in patient with type 2 diabetes mellitus. A cross-sectional study

BACKGROUND AND AIMS

Few studies have evaluated the attitudes of patients with type 2 diabetes mellitus (T2DM) towards the given dietary plans. In this study, we aimed to evaluate: i) the self-reported adherence of T2DM patients to the prescribed diets; ii) the use of other types of diet schemes; iii) the patients' preferences towards the type of meal plans.

METHODS AND RESULTS

A 16 multiple-choice items questionnaire was administered to 500 T2DM patients; 71.2% (356/500) of them had the perception of having received a dietary plan; only 163/356 declared to be fully adherent. The latter had lower BMI (25.8 ± 4.5 vs 29.1 ± 4.5 kg/m², p < 0.001) than patients who were partly adherent. Among patients not following the given diet, 61.8% was eating in accordance to a self-made diet and 20.9% did not follow any diet. Only a few patients (2.4%) had tried a popular diet/commercial program. Most patients preferred either a "sufficiently free" (201/500) or a "free" (218/500) scheme. The use of supplements attracted younger, obese individuals, with higher education, and most managers. In a multinomial regression model, age and diabetes duration were inversely associated with the choice of a "rigid" scheme, diabetes duration and glycated hemoglobin levels were inversely correlated with a "free" diet choice, obesity was associated with a "strategic" scheme choice, while lower education (inversely) and obesity (directly) correlated with the preference for "supplement use".

CONCLUSIONS

Socio-cultural/individual factors could affect attitudes and preferences of T2DM patients towards diet. These factors should be considered in order to draw an individually tailored dietary plan.

The obesity gene and colorectal cancer risk: a population study in Northern Italy

BACKGROUND

Representing the second cause of cancer-related death after lung cancer in men and breast cancer in women, colorectal cancer (CRC) is a major health problem in Italy. Obesity is reckoned to favor CRC; however, the underlying mechanisms are unclear. Recently, a single nucleotide polymorphism (SNP) in the fat mass and obesity associated (FTO) gene was found to be significantly associated with obesity.

AIMS

To establish whether the FTO SNP rs9939609 may represent a risk factor for CRC and adenoma in the Italian population.

PATIENTS AND METHODS

1,037 subjects were enrolled in the study and divided in 3 groups: CRC (341 pts., M/F=197/144, mean age=65.17±11.16 years), colorectal adenoma (385 pts., M/F=247/138, mean age=62.49±13.01 years), healthy controls (311 pts., M/F=150/161, mean age=57.31±13.84 years). DNA was extracted from whole blood, and stored frozen for rs9939609 genotyping by real-time PCR.

RESULTS

The frequency of the obesity-associated mutated A allele (AA+AT) on the FTO gene was 69.77% among controls, and 71.85% and 65.71% respectively among CRC and polyp patients. Compared to control subjects the AA+AT genotype had no significant effect on the risk for either CRC (OR=1.106; CI 95%=0.788-1.550; p=0.561) or colorectal adenomas (OR=0.830; CI 95%=0.602-1.144; p=0.255). We did not observe any association between the AA genotype and CRC/polyp localization and age at diagnosis. As measured in a patient subset, carriership of the risk alleles did not reflect in a significantly altered BMI.

CONCLUSION

The obesity-linked FTO variants do not play a significant role in modulating the colorectal cancer risk in the Italian population.

Clinical and biochemical parameters related to cardiovascular disease after Helicobacter pylori eradication

AIM

Since the major established risk factors explain the pathogenesis of ischemic heart disease (IHD) in a proportion of cases, it is crucial to search for other causal mechanisms. The possible link between IHD and Helicobacter pylori (H.pylori) infection has been reported. However, the precise mechanism of this potential relationship, by a proinflammatory activity or metabolic disorder, is unclear. In order to investigate this issue, the authors assessed changes in clinical and biochemical parameters related to IHD after bacterial eradication.

METHODS

A total of 496 patients (281 males; mean age 59.7+/-2.3) with H.pylori-positive dyspepsia and/or peptic ulcer were studied after cure of the bacterium. H.pylori status was determined by histology or 13C-urea breath testing. Examinations for body mass index, diastolic blood pressure and blood testing (C-reactive protein, fibrinogen, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, fasting glucose) were performed before eradication and annually for up to five years thereafter. For statistical analyses, the Student's t test was performed.

RESULTS

HDL-C increased (P=0.02) while C-reactive protein and fibrinogen levels diminished (P<0.0001) significantly. BMI and diastolic blood pressure increased in a significant (P=0.032 and P=0.039 respectively) manner compared to baseline.

CONCLUSIONS

H.pylori eradication is associated with modification of some clinical and biochemical parameters related to IHD during a follow-up of five years. There is a need for large interventional randomized studies in order to prove a causal association.

Four years of treatment with lamivudine: clinical and virological evaluations in HBe antigen-negative chronic hepatitis B

AIM

To evaluate the clinical and virological impact of the prolonged use of lamivudine in 94 patients with HBe antigen-negative chronic hepatitis B.

METHODS

Initial virological and biochemical responses were obtained in 84 (89%) and in 83 (88%) patients respectively.

RESULTS

The virological response peaked within the first 12 months, but diminished to 39% at 48 months because of drug resistance. Overall a virological breakthrough developed in 44 patients (52.4%). After virological breakthrough, the actuarial probability of maintaining biochemical remission diminished to 15% at 24 months and 0% at 29 months. There was no response in 10.6%. Polymerase gene mutations were observed in 82.5% of virological breakthroughs but also in 75% of the non-responders. Overall 7.4% of patients developed a hepatocellular carcinoma.

CONCLUSION

Almost 90% of patients responded initially to lamivudine but the emergence of drug resistance progressively reduced the rate of virological remission to 39% at the fourth year of therapy. YMDD mutants explained the 75% of lamivudine resistances and were also selected very early in non-responders. Although the biochemical response is invariably lost within 29 months of the YMDD mutant's duration, the clinical outcome was benign despite severe postvirological breakthrough hepatitic flares in about 12% of cases.

The use of the anti-tumour necrosis factor monoclonal antibody--infliximab--to treat ulcerative colitis: implications and trends beyond the available data

The monoclonal antibody to the tumour necrosis factor--infliximab--has recently been added to the list of off-label therapeutic means for ulcerative colitis. We conducted a descriptive analysis of the results from studies on the use of the drug published so far. A total of 187 patients qualified for analysis. They were divided into four main categories, including steroid-refractory and responsive adults and children. The median frequencies of an early and a sustained response were 77 and 44.5%. These data suggest that adult non-steroid-refractory, and paediatric patients may respond with the highest frequency. While it is obligatory to wait for the yield of the ongoing controlled trials before any conclusion on these indications is drawn, the data provide seminal ideas to further investigations, including the hypothesis to inaugurate with infliximab a top-down strategy for the treatment of inflammatory bowel disease.

[Need for hospital admission in patients with ulcerative colitis during maintenance with azathioprine]

AIM

The aim of this study is to analyse the clinical course of ulcerative colitis during maintenance therapy with azathioprine, a drug which is still not proved to be able to modify the natural history of the disease.

METHODS

A retrospective study is made of data regarding the frequency of hospital admission for patients with ulcerative colitis referring to a gastroenterological Day-Hospital between 1991 and 2000. The disease history of these patients has been divided into 2 sections: one preceding and the other following an index-event, identified as the beginning of a maintenance regimen with azathioprine; this allowed to find possible differences in the clinical course after the index-event. Patients were controls of themselves.

RESULTS

Seventeen patients qualified for analysis. Remission from an acute severe attack of ulcerative colitis was reached by intravenous or oral cyclosporine for 14 of them and by prednisone for 3 of them. The maintenance treatment with azathioprine, which started in all but 1 patient (intention-to-treat), showed a reduction in the number of hospital admissions, decreasing from a mean of 2.12+/-0.69 in the preceding 4.2+/-4.3 years to a mean of 0.12+/-0.33 in the following 5.8+/-2.5 years (p=0.000).

CONCLUSIONS

Patients undergoing maintenance therapy with azathioprine showed face fewer relapses needing hospitalisation than those without azathioprine.

Long-term efficacy of oral microemulsion cyclosporin for refractory ulcerative colitis

AIM

The 60% bioavailable oral microemulsion formulation of cyclosporin (NEORAL ), has replaced the intravenous route to treat both organ transplant and immune-based disease. Its use for steroid-refractory ulcerative colitis (a recognized indication for intravenous cyclosporin) has been scanty.

METHODS

Twenty-three consecutive patients (14 male/9 female, universal colitis 14/23) entered a 3-month course of NEORAL (initially dosed at 5 mg/kg/day) because of steroid-refractoriness (14 cases) and steroid-dependence (9 cases). Responders (at least showing a 50% reduction of a clinical activity score) were continued on azathioprine. The initial steroid dose was tapered on commencing NEORAL; patients requiring steroid resumption or increase in the follow-up were defined as relapsers.

RESULTS

The target trough concentration of 200 ng/ml of whole blood was achieved without major titration in all but 1 patient. There were 7 non-responders (30%). Of the 16 responders (70%), 2 have not relapsed; the remaining 14 relapsed at the median time of 9.5 months (1.5-60) with 10 (71%) showing only 1 relapse. Five patients were colectomized 12 months after NEORAL (1.5-24), leaving 11 of the initial 23 (47%) with their colon. Of the 16, all but 1 had azathioprine; the median daily steroid needs fell from 32 to 5 mg.

CONCLUSION

The rates of acute and chronic response of 70% and 47% achieved by NEORAL in this indication duplicate the figures achieved by the traditional schedules of cyclosporin administration.

[The team approach]

Teamwork is emerging like a model of prevailing reference in many working fields: the interaction and, above all, integration between several persons can be an instrument to empower the individual skills, allowing to reach different and higher levels of creativity and efficiency than the sum of the single members' capacities. However, the capacity of interaction, tolerance, and focusing on the problem is required to the members who also need training for this way of working. After a brief historical summary of some ''creative groups'' experiences in the fields of literature, science and arts, a vast review of theoretical model references is presented. Starting from specific North-American guidelines, a hypothesis of nutritional teamwork is introduced. This hypothesis aims at optimizing therapeutic interventions, at the critical review of the provided services and at a greater care for the cost-benefit ratio.

Expression and antigenic characterization of recombinant Mycoplasma agalactiae P48 major surface protein

The gene encoding the P48 major surface lipoprotein of M. agalactiae has been recently characterised. Since its product plays an important role in the immune response of infected animals, in this study we analysed a recombinant P48 expressed in E. coli. Multiple point mutations were introduced by site directed mutagenesis in order to convert four tryptophan TGA codons, which are a typical feature of the mycoplasma genetic code, into the standard TGG. The mutated p48 gene was subcloned into pGex-2T and expressed in fusion with glutathione-S transferase. Following purification steps, P48 was eluted from carrier protein by thrombin digestion and used in Western blot and indirect ELISA using well-characterised sheep sera. Results demonstrate that specific antibodies against P48 are detected 3 weeks after onset of clinical disease and the recombinant P48 is a diagnostically relevant marker of M. agalactiae infection.

P48 major surface antigen of Mycoplasma agalactiae is homologous to a malp product of Mycoplasma fermentans and belongs to a selected family of bacterial lipoproteins

A major surface antigenic lipoprotein of Mycoplasma agalactiae, promptly recognized by the host's immune system, was characterized. The mature product, P48, showed significant similarity and shared conserved amino acid motifs with lipoproteins or predicted lipoproteins from Mycoplasma fermentans, Mycoplasma hyorhinis, relapsing fever Borrelia spp., Bacillus subtilis, and Treponema pallidum.

Improving accuracy of bone resections using robotics tool holder and a high speed milling cutting tool

The use of non-cemented prosthetic components in implant surgery is demanding a high quality of bone beds in order to allow for a good level of osseointegration. Two parameters are significant in the evaluation of the quality of the host bone: roughness, which reports on the presence of gaps and peeks, and flatness, which reports on the total percentage of bone which lies in a given interval from the prosthesis. Robot assisted cutting of 32 pig femours and tibiae was performed using various techniques and options. This paper demonstrates roughness and flatness can be taken of the order of the limits necessary for osseointegration, by using a milling cutting tool mounted on a strong support, in this case a robot arm, improving on the results obtained by similar studies referred to hand sawed bones by 10 times.

Outcome of cancer patients receiving home parenteral nutrition. Italian Society of Parenteral and Enteral Nutrition (S.I.N.P.E.)

BACKGROUND

Indication for home parenteral nutrition (HPN) in cancer patients is controversial because intestinal failure and malnutrition are often only two of the many problems found in such patients that may deserve priority of treatment.

METHODS

This was a retrospective study of 75 cancer patients from nine institutions included in the Italian HPN Registry. The patients had a mean weight loss of 12.5%, serum albumin of 3.1 g/dL, lymphocyte count of 1150/mm3, and serum total iron-binding capacity of 190 micrograms/dL. The main indication for HPN was intestinal obstruction (66%); 72% of the patients had metastatic disease. A series of demographic, oncologic, and nutritional characteristics were analyzed in an attempt to predict a possible benefit of HPN.

RESULTS

A total of 9897 days of HPN were delivered to 75 cancer patients, for a median of 4 months (range 1 to 15 months) per patient. Sixty-nine patients died while receiving HPN, five had a remission of their intestinal failure, and one chose to stop the treatment. Complications related to parenteral nutrition were as follows: 19 cases of sepsis, 6 catheter occlusions, 4 catheter dislocations, and 2 metabolic imbalances. HPN preserved nutritional status and slightly improved weight, lymphocyte count, serum albumin, and Karnofsky performance status in patients who survived > 3 months. Quality of life during HPN was judged by the clinicians to have improved in only 9% of those who survived < 3 months, but in 68% of the patients who survived for > 3 months. Karnofsky performance status > 50 at the start of HPN was correlated with longer survival (p = .02).

CONCLUSIONS

Our study demonstrated a positive effect of HPN on nutritional status and quality of life in patients who survived > 3 months and suggests that HPN should be avoided when Karnofsky performance status is < 50.

Minimally invasive 3D data registration in computer and robot assisted total knee arthroplasty

Computer and robot assisted surgery is concerned with the improvements achievable by using computer methods and robotic devices to plan and execute surgical interventions. The registration of different coordinate frames, often achieved through the matching of 3D data sets, represents a crucial step connecting planning and execution. Orthopaedic surgery already features a number of functioning applications which include registration routines relying on presurgically implanted fiducial markers. Replacing such invasive routine with non-fiducial registration procedures is regarded as a necessary step towards a minimisation of surgical invasiveness. A minimally invasive registration technique based on the iterative closest point algorithm is presented and conceived for a specific computer and robot assisted orthopaedic reconstructive intervention, namely total knee arthroplasty. The whole surgical protocol is examined in detail and the experimental results, relative to tests performed on synthetic and animal specimens, are thoroughly reported and discussed. The authors indicate that the proposed registration approach is well-suited for the relevant application and appropriate for in vivo testing.

Use of a biocompatible fiducial marker in evaluating the accuracy of computed tomography image registration

RATIONALE AND OBJECTIVES

Accurate registration of computed tomography (CT) images to the patient is crucial for computer-assisted surgery. Markers used in roentgen stereo-grammetric analysis (RSA) can be located in a CT scan using a novel approach and also can be located physically. Roentgen stereo-grammetric analysis data act as "ground truth" for the three-dimensional marker locations.

METHODS

Two foam-bone phantoms were marked. The markers were scanned seven times with RSA, three times with axial CT, and contacted four times with a coordinate measuring arm. Root-mean-square (RMS) errors were derived for the registrations.

RESULTS

Computed tomography and RSA data register to 0.15 mm RMS error. Computed tomography and arm data register to 0.25 mm. The markers are biocompatible, and the coordinate measuring arm is usable in an operating room.

CONCLUSIONS

Typical in vitro registration errors are approximately 2 mm. The authors have developed a marker that provides superior registration, and a procedure that can be used for in vivo studies.

Ultrastructural appearance of chondroblastoma

The ultrastructural appearance of two chondroblastoma were examined by scanning and transmission electron microscopy. The polygonal basal cells, with a scanty pericellular matrix, show a poorly developed endoplasmic reticulum and many Golgi bodies. The highly differentiated chondroid cells are assembled in isogenous clusters and show intracytoplasmic inclusions of glycogen and lipids, numerous mitochondria and superficial secretion vesicles arising from a well developed rough endoplasmic reticulum. Clusters of crystals, in close contact with the matrix collagen fibres are found near to the tumour cells. These ultrastructural characteristics, together with the basal undifferentiated cells that proliferate and differentiate into cartilaginous tissue, distinguish this neoplasm from chondroma, mesenchymal chondrosarcoma and chondromyxoid fibroma and confirm its chondroid origin.

Scanning electron microscopy of osteoid osteoma

We have examined the organic components of the nidus of an osteoid osteoma in 4 patients using scanning electron microscopy. Different organisation of the osteoblastic cells and of the fibrous structures of the osteoid matrix in different zones was demonstrated. These findings indicated a greater degree of immaturity in the centre, as compared with the peripheral area where the process of differentiation was more evident.

Dermatophilosis in sheep: first report in Italy, experimental reproduction and evaluation of immune response

A severe exudative-crustous and proliferous dermatitis in a 2 year old sheep caused by Dermatophilus congolensis (observed for the first time in Italy), is reported. The disease was reproduced experimentally in sheep, goats, rabbits and guinea pigs, whose skin was treated in different ways before infection. E.L.I.S.A. and Immunoblotting tests carried out in experimentally infected sheep, showed the antigenic complexity of the pathogen and the existence of cross-immunity to the protein components. Intradermoreaction tests were carried out in all animals. The development of a positive reaction only in rabbits and guinea pigs, confirmed that these animals have a cellular immunity against Dermatophilus congolensis.

Human articular cartilage during osteoarthrosis: a study under the scanning electron microscope

The present study has been carried out with the aim of contributing, by means of the Scanning Electron Microscope (SEM), to the understanding of morphological changes in human articular cartilage during osteoarthrosis. Fragments from the femoral head of 10 patients subjected to total hip joint prosthesis were cryofractured and then studied by SEM after treatment with current procedures. The images obtained were considered observing the division of cartilage into superficial, medium and deep layers. The superficial layer is the one which suffers most seriously during osteoarthrosis, but collagen alterations, as fibrillation, involve all the layers together. Moreover, the observation of deformed cellular lacunae in the deep layer suggests that a precocious functional collapse involves the whole thickness of the cartilage, probably due to a metabolic suffering.

Peripheral chondrosarcoma: ultrastructural investigation by transmission and scanning electron microscopy

Ultrastructural analysis by transmission and scanning electron microscopy was performed on two grade 1 peripheral chondrosarcomas which had arisen from a preexisting osteochondroma. This analysis allowed us to determine the morphologic changes in both the cell and the matrix and suggested a low grade of malignancy. We emphasize that ultrastructural analysis with scanning and electron microscopy is only valid when conducted on representative areas of the tumor.

[3-dimensional characterization of the synoviocytes of the human synovial intima]

The intimal synovial surface in normal conditions, using a scanning electron microscope, has been studied. The three synovial membrane types are clearly recognizable: fibrous (Fig. 8), adipose (Figs. 9 and 10) and areolar (Figs. 1 and 2); but only in the areolar type, the characterization of the main two cellular types: synoviocytes B and A, is possible. Synoviocyte B represents the constitutive element which characterizes the synovial intima; it has a cellular body of irregular shape and long cytoplasmic processes directed towards the joint cavity (Figs. 3, 4 and 5). The cellular body and the cytoplasmic processes are covered by small blebs (Fig. 6). and similar vesicles, probably of the same cellular origin, are scattered throughout the extracellular matrix. These cells are likely responsible for the specific structure of the interstitial tissue adapted to the exchanges and to the regulation of the composition of the synovial fluid (Okada et. al. 1981; Linck and Porte, 1978, 1981). Synoviocyte A is a small minority; it has many long and irregular membrane infoldings which define a complicated system of intracellular canaliculi of various depth (Fig. 7). The ultrastructural characteristics of their surface and the peculiarity of their organelle apparatus, described by other AA. (Fell et. al., 1976), demonstrate that these elements carry out a macrophagic function. The clear majority of the synoviocytes B in the intimal surface suggests that in normal conditions, the synthesizing processes prevail over the phagocytosis ones.

[Changes and long-term evaluation of incisal angle in surgical-orthodontic treatment of skeletal Class III]

The finding from this research is to analyse, in Class III scheletric-malocclusion patients the stability of the upper and lower incisor teeth, a few years after the surgical-orthodontic treatment. It has been pointed out the parodontal condition too.

[A clinical contribution to the conservative surgical therapy of giant follicular cysts of the mandible]

Three clinical cases of mandibular giant follicular cyst were described. Personal experience with an initial conservative approach is described and some interesting conclusions about the short time of bone new generation of maxillary are presented. As soon as possible, the extraction of impacted tooth will be made without the risk of mandibular fracture or vascular-nervous lesions.

Morphological aspects of the synovial membrane and the femoral epiphyseal nucleus in anemia induced experimentally (note 1)

The authors describe the macroscopic and ultra-structural changes in the synovial membrane and the growth nucleus consequent to anemia induced experimentally. In the anatomical region studied an early and a late response to the transitory anoxia is observed. The former is represented by the accentuation of the macrophagic activity of the A synoviocytes and by pictures of trabecular fragmentation. The latter is represented by hyperplasia of the synovial membrane, a reduction in the thickness of the joint cartilage, and by early and patchy calcification of the epiphyseal disc.

Ultrastructural characteristics of the human synoviocytes

The purpose of this study was to identify, by the scanning electron microscopy, the behaviour of the different cell types in the normal human synovial intima, in order to obtain information useful for interpreting pathological changes in the synovium. Our observations revealed that, in numerous areas of the synovial membrane (adipose or fibrous type), the synoviocytes were dispersed and the intercellular matrix, covered only by the cytoplasmic processes of cells deeply located, was in direct contact with the joint cavity. In the areolar type of the synovium the synoviocytes were more numerous; they tended to concentrate to give the appearance of a continuous tissue; but between the cells very large intercellular spaces were usually present. In this latter membrane type we identified the two main cellular types of the synoviocytes: A and B. B-synoviocytes were the predominant cell type of the synovium. These cells were characterized by long cytoplasmic processes, perpendicularly directed towards the joint cavity. Both the cellular body and the cytoplasmic processes were covered by small blebs and vesicles of various size. The A-synoviocytes were a small minority, rarely dispersed between the B-synoviocytes. They were characterized by numerous membrane infoldings which delimited intracellular canaliculi of various depth. Our ultrastructural observations demonstrated that, in normal conditions, the B-synoviocyte must be considered as a constitutive element which characterized the synovial intima, responsible for the specific structure of the interstitial tissue and for the regulation of the composition of the synovial fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison between computerized tomography and myelography in radicular lumbar syndromes

The clinical, tomographic and myelographic findings in 40 patients with radicular lumbar syndromes are analysed and discussed. The study shows that indications for surgical treatment must take into account errors in determining the level of the syndrome based on clinical examination (25%), false negatives (10%), and false positives (15%) resulting from CT scan and, finally, false negatives resulting from myelography (10%). It is emphasized that at present there is no real evidence to support preference for one or other of these instrumental tests. Only the clinical examination is capable of evaluating each case individually and thus providing the most reliable indications on which to base both diagnosis and treatment.

Clinical and electrophysiological investigation of the results of operation for lumbar disc hernia. Preliminary results

The long-term results of operations to remove disc hernias were assessed clinically and electrophysiologically in two groups of patients treated by different surgical techniques. The electrophysiological parameters determined were the motor conduction speed of the sciatic nerve, the H reflex, the minimum latency of the F wave and quantitative analysis of the EMG by the Willison method. The preliminary results reported in the present paper are related to two comparable samples of patients who underwent hemilaminoarthrectomy or hemilaminectomy for disc hernia at L5-S1. They show that the incidence of after effects was lower in the patients treated by simple hemilaminectomy.

Quantitative analysis of the bone destroying activity of osteocytes and osteoclasts in experimental disuse osteoporosis

With the aim of analysing the role played by osteocytes in phospho-calcic homeostasis and in bone metabolism, the amount of bone tissue respectively reabsorbed by osteocytes and by osteoclasts had morphometrically been evaluated in unloaded skeletal segments.