A potentiometric and spectrofluorimetric approach to unravel inhibitory effects of semi- and thiosemicarbazones on mushroom tyrosinase activity

The inhibitory effects on mushrooms tyrosinase activity of some semi- and thiosemicarbazones were investigated. While the semicarbazones are inactive, the thiosemicarbazones are, in general, more active than the reference (kojic acid, IC₅₀ = 70 μM), with maximum activity obtained with benzaldehyde thiosemicarbazone (IC₅₀ = 7 μM). These inhibitors probably act by coordination of the copper(II) metal ions in the active site of tyrosinase: effectively, potentiometric studies conducted in water solutions confirm that the most active thiosemicarbazone is a good ligand for copper(II) ions. The tyrosinase CD spectra do not show any significant difference by addition of an inhibitor or an inactive compound. On the contrary, interesting results were obtained by spectrofluorimetric titrations of mushrooms tyrosinase aqueous solutions with some of the investigated compounds, giving helpful information about possible mechanism of action. The thiosemicarbazones here reported are not cytotoxic on human fibroblasts and do not activate cells in a pro-inflammatory way.

Multidimensional Short Tools to assess frailty: a narrative review

BACKGROUND

The population of the European Union is progressively ageing, therefore frailty is becoming a crucial public health issue. In recent years there is a growing interest in a multidimensional concept of frailty, that is not only physical but also psychological and social, in line with a person-centered care.

STUDY DESIGN

To measure frailty represents a fundamental step to evaluate the needs for care at both population and individual levels. Of course, to assess frailty in a large population is essential to find short and quick tools able to give reliable results in terms of risk of occurrence of negative events, to stratify older adults according to their frailty level. In this way the most appropriate strategies can be chosen and applied, to delay the functional decline associated to frailty and its consequences, such as hospitalization, institutionalization, low quality of life, and death.

METHODS

In this review we searched on PubMed for articles about scales assessing frailty with peculiar characteristics: published for the first time in 2010, available in English, with a short length and duration of administration, composed by multidimensional domains.

RESULTS

Seven scales were found and analyzed: The Zulfiqar Frailty Scale (ZFS), The Pictorial Fit-Frail Scale (PFFS), The Tilburg Frailty Indicator (TFI), The SUNFRAIL Tool, The (fr)AGILE, The Risk Instrument for Screening in the Community (RISC) and The Short Functional Geriatric Evaluation (SFGE). We compared their main features as the number of questions, the time for administration, the domains used and the psychometric properties as validity and reliability, with the aim of providing a set of useful information to health professionals in their everyday work.

CONCLUSIONS

The use of these tools provides important information to help plan community health and social care and meet individuals' needs for care, but this approach is not common for community care in the EU yet.

In response to the Letter to the Editor by Dr AA. Zulfiqar re our publication "Multidimensional Short Tools to Assess Frailty: a Narrative Review" (Ann Ig. 2022 Mar 18. doi: 10.7416/ai.2022.2516. Online ahead of print)

We appreciate that Dr. Zulfiqar showed us that they had already demonstrated the validity and reliability of his ZFS scale. Still, it is evident that, in our paper, we could not take it for granted because all the articles they quote have been published after we handed out ours to the Managing Editor of Ann Ig.

Predictors of ER access of frail elderly: a way to fighting the COVID-19 outbreak

Background

The overcrowding of the Emergency Room (ER) by the elderly is still a focus of public health policies, also due to the recent COVID-19 outbreak. Health policies have tried to mitigate the high use of ER by implementing community care on health demand in the absence of a plan to manage the increasing request of out-of-hospital care. This study aimed to investigate the predictors of Emergency Room Access (ERA) and No-Urgent Emergency Room Access (NUERA) of community-dwelling frail older adults.

Methods

An observational longitudinal cohort study was carried out. The cohort was made up of 1246 community-dwelling frail older adults (over 64) residents into the Latium Region. The ER admission rate was assessed over three years from the baseline administration of the Functional Geriatric Evaluation questionnaire to evaluate Bio-Psycho-Social Frailty. The GENLIN ordinal regression model was used to identify the predictors of ERA and NUERA.

Results

Mean age was 73.6 (SD ± 7.1) years, and 53.4% were female. The sample was stratified in Robust (43.5%), Pre-frail (35.8%), Frail (14.0%), and Very Frail (7.3%). The ordinal logistic regression model highlighted the predictive role of comorbidity (OR = 1.13, p < 0.001) and frailty level (OR = 1.29, p < 0.001) for ERA. With regard to NUERA, the predictors were social network (OR 0.54, P-value = 0.015) and) and a medium score of pulmo-cardio-vascular function (OR 1.50, P-value = 0.006).

Conclusions

Comorbidity and lack of social support impacted ER access and the overcrowding of the emergency department. Overall bio-psycho-social frailty represents an indicator of the frequency of ER accesses. This study could support policymakers and public health professionals in implementing community health care and defining and meeting the demand for care of non-frail individuals.

Key messages

The overcrowding of the Emergency Room (ER) by the elderly is still a focus of public health policies, also due to the recent COVID-19 outbreak. Comorbidity and lack of social support impacted ER access and the overcrowding of the emergency department.

From the bench to practice - Field integration of community-based services for older citizens with different levels of functional limitation across European Regions

The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe.

The study design is a mixed method approach. Based on data analysis from a cohort of community-dwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report.

All working groups agreed on a common understanding that integration of care means person-centered integration of health and social care, longitudinally provided across primary and secondary health care including citizens’ individual social, economic and human resources.

Elements for consideration during care for pre-frail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery.

The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach.

The effect of community nurse on mortality and hospi- talization in a group of over-75 older adults: a nested case-control study

Background

Bio-psycho-social frailty can negatively affect the health status of an ageing population. The integration between community nurses and social services can emphasize community care and prevent the onset of both health and social negative outcomes in the older population. The aim of the paper is to explore the causal association through the analysis of the hospitalization and mortality rate after a pro-active social service integrated by the community nurse.

Study Design

A nested case-control study comparing groups of older adults has been carried out. Methods. The paper compares data stem from a cohort followed up by the University of Rome "Tor Vergata" with data from the "Long Live the Elderly!" program (LLE) cohort.

Results

One-year standardized mortality rate was 6.5%, 4.7% and 7.5% in the control group, the LLE group and the LLE group integrated by the community nurse (LLE-CN), respectively. One-year hospitalization rate was 15.4%, 15.5% and 10.8% in the control group, the LLE group and the LLE-CN group, respectively.

Conclusions

According to our results a social service with a pro-active approach, integrated by the community nurse, appears to be able to reduce mortality and hospitalization in a group of older adults aged>75. The multidimensional assessment of frailty stands for the first step of a new organization of community services.

Management of bio-psycho-social frailty to reduce hospital use and improve survival of older adults

Background

Ageing of population is associated to the increase of care demand. Many health systems are still centered on hospital care, that sometime is not appropriate. The shift from hospital to community care requires a new model of service delivery. Aim of this paper is to assess the impact of a community service based on the assessment of frailty, on mortality and use of hospital care by older adults.

Methods

A cohort made up by 8,592 over-75 subjects (67.1% female, mean age 84.5; SD ± 5.29) has been assessed once a year for bio-psycho-social frailty by the administration of the Short Functional Geriatric Evaluation questionnaire. The enrolled subjects were involved in a Community-based pro-Active Monitoring Program which provides interventions aimed at reducing social isolation. Mortality, use of hospital care and use of residential long-term care have been recorded during the follow up and separate and cumulative incidence rate was measured.

Results

The sample was stratified in Robust (37.5%), Pre-frail (24.0%), Frail, (29.5%) and Very Frail (9.1%) individuals. Mortality, Hospital admission rate and Residential LTC admission rate were higher in the very frails than among the other groups. However, according to social isolation, the integrated subjects at the baseline assessment, showed the highest incidence of negative events: 29.5%, 20.8%, 21.0%, .and 20.8% for integrated, mild isolated, moderate isolated and severely isolated individuals respectively (p < 0.001). The logistic regression analysis, adjusted for age, gender and level of frailty, confirmed the protective role of reducing social isolation among isolated individuals compared with integrated ones (OR: 0.729; CL95% 0.673-0.720).

Conclusions

The assessment of bio-psycho-social frailty could be the starting point for effective intervention at community level, like the program mentioned above. Management of frailty may lead to an improvement of public health outcomes.

Key messages

Intervention dealing with social isolation are able to revert the increase of mortality related to the lack of social resources. Management of frailty may lead to an improvement of public health outcomes.

Hepatotoxicity induced by greater celandine (Chelidonium majus L.): a review of the literature

The available literature assessing Chelidonium majus L. (CM) hepatotoxicity potential, and its risk to benefit assessment has been reviewed in this paper. Identification of significant scientific literature was performed via the following research databases: Cochrane Central, Google Scholar, EMBASE, Medline, Science Direct, Scopus, Web of Science, using the following keywords: "Chelidonium majus", "greater celandine", "Hepatotoxicity", "Liver" "Injury", "Toxicity" individually investigated and then again in association. CM named also greater celandine, swallow-wort, or bai-qu-cai (Chinese), has been used for a long time in traditional Chinese medicine and phytotherapy. Its extracts have been claimed to display a wide variety of biological activities: antimicrobial, anti-inflammatory, spasmolytic, antineoplastic, hepatoprotective, and analgesic. Moreover, herbal medicine suggests this plant have numerous additional effects which have not yet been scientifically evaluated, such as antitussive, diuretic, and eye-regenerative. However, despite its claimed hepatoprotective effects, several hepatotoxicity cases have been reported to be probably or highly probably connected with CM exposure, after their evaluation through liver-targeted causality assessment methods. CM hepatotoxicity has been defined as a distinct form of herb-induced liver injury (HILI), due to an idiosyncratic reaction of the metabolic type. This evidence has to be considered in relationship with the absence of considerable benefits of CM therapy. Therefore, the risk to benefit ratio of the use of herbal products containing greater celandine can actually be considered as negative.

Efficacy and tolerability of bendamustine, bortezomib and dexamethasone in patients with relapsed-refractory multiple myeloma: a phase II study

Bendamustine demonstrated synergistic efficacy with bortezomib against multiple myeloma (MM) cells in vitro and seems an effective treatment for relapsed-refractory MM (rrMM). This phase II study evaluated bendamustine plus bortezomib and dexamethasone (BVD) administered over six 28-day cycles and then every 56 days for six further cycles in patients with rrMM treated with ⩽4 prior therapies and not refractory to bortezomib. The primary study end point was the overall response rate after four cycles. In total, 75 patients were enrolled, of median age 68 years. All patients had received targeted agents, 83% had 1–2 prior therapies and 33% were refractory to the last treatment. The response rate⩾partial response (PR) was 71.5% (16% complete response, 18.5% very good PR, 37% partial remission). At 12 months of follow-up, median time-to-progression (TTP) was 16.5 months and 1-year overall survival was 78%. According to Cox regression analysis, only prior therapy with bortezomib plus lenalidomide significantly reduced TTP (9 vs 17 months; hazard ratio=4.5; P=0.005). The main severe side effects were thrombocytopenia (30.5%), neutropenia (18.5%), infections (12%), neuropathy (8%) and gastrointestinal and cardiovascular events (both 6.5%). The BVD regimen is feasible, effective and well-tolerated in difficult-to-treat patients with rrMM.

Protein intake during gestation affects postnatal bovine skeletal muscle growth and relative expression of IGF1, IGF1R, IGF2 and IGF2R

Expression of insulin-like growth factor (IGF)1 and IGF2 and their receptor (IGF1R and IGF2R) mRNA in fetal skeletal muscle are changed by variations in maternal nutrient intake. The persistence of these effects into postnatal life and their association with phenotype in beef cattle is unknown. Here we report that the cross-sectional areas of longissimus dorsi and semitendinosus (ST) muscles were greater for mature male progeny born to heifers fed low protein diets (70% vs. 240% of recommended) during the first trimester. In ST, this was accompanied by greater IGF1, IGF2 and IGF2R mRNA at 680 d. Females exposed to low protein diets during the first trimester had decreased IGF2 mRNA in ST at 680 d, however this did not result in an effect to phenotype. Exposure to low protein diets during the second trimester increased IGF1R mRNA in ST of all progeny at 680 d. Changes to expression of IGF genes in progeny skeletal muscle resulting from variations to maternal protein intake during gestation may have permanent and sex-specific effect on postnatal skeletal muscle growth.

Maternal nutrient restriction in early pregnancy programs hepatic mRNA expression of growth-related genes and liver size in adult male sheep

The liver is a major metabolic and endocrine organ of critical importance in the regulation of growth and metabolism. Its function is determined by a complex interaction of nutritionally regulated counter-regulatory hormones. The extent to which hepatic endocrine sensitivity can be programed in utero and whether the resultant adaptations persist into adulthood is unknown and was therefore the subject of this study. Young adult male sheep born to mothers that were fed either a control diet (i.e.100% of total live weight-maintenance requirements) throughout gestation or 50% of that intake (i.e. nutrient restricted (NR)) from 0 to 95 days gestation and thereafter 100% of requirements (taking into account increasing fetal mass) were entered into the study. All mothers gave birth normally at term, the singleton offspring were weaned at 16 weeks, and then reared at pasture until 3 years of age when their livers were sampled. NR offspring were of similar birth and body weights at 3 years of age when they had disproportionately smaller livers than controls. The abundance of mRNA for GH, prolactin, and IGF-II receptors, plus hepatocyte growth factor and suppressor of cytokine signaling-3 were all lower in livers of NR offspring. In contrast, the abundance of the mitochondrial protein voltage-dependent anion channel and the pro-apoptotic factor Bax were up regulated relative to controls. In conclusion, maternal nutrient restriction in early gestation results in adult offspring with smaller livers. This may be mediated by alterations in both hepatic mitogenic and apoptotic factors.

Prolactin and the expression of suppressor of cytokine signaling-3 in the sheep adrenal gland before birth

The fetal pituitary-adrenal axis plays a key role in the fetal response to intrauterine stress and in the timing of parturition. The fetal sheep adrenal gland is relatively refractory to stimulation in midgestation (90–120 days) before the prepartum activation, which occurs around 135 days gestation (term = 147 ± 3 days). The mechanisms underlying the switch from adrenal quiescence to activation are unclear. Therefore, we have investigated the expression of suppressor of cytokine signaling-3 (SOCS-3), a putative inhibitor of tissue growth in the fetal sheep adrenal between 50 and 145 days gestation and in the adrenal of the growth-restricted fetal sheep in late gestation. SOCS-3 is activated by a range of cytokines, including prolactin (PRL), and we have, therefore, determined whether PRL administered in vivo or in vitro stimulates SOCS-3 mRNA expression in the fetal adrenal in late gestation. There was a decrease ( P < 0.005) in SOCS-3 expression in the fetal adrenal between 54 and 133 days and between 141 and 144 days gestation. Infusion of the dopaminergic agonist, bromocriptine, which suppressed fetal PRL concentrations but did not decrease adrenal SOCS-3 mRNA expression. PRL administration, however, significantly increased adrenal SOCS-3 mRNA expression ( P < 0.05). Similarly, there was an increase ( P < 0.05) in SOCS-3 mRNA expression in adrenocortical cells in vitro after exposure to PRL (50 ng/ml). Placental and fetal growth restriction had no effect on SOCS-3 expression in the adrenal during late gestation. In summary, the decrease in the expression of the inhibitor SOCS-3 after 133 days gestation may be permissive for a subsequent increase in fetal adrenal growth before birth. We conclude that factors other than PRL act to maintain adrenal SOCS-3 mRNA expression before 133 days gestation but that acute elevations of PRL can act to upregulate adrenal SOCS-3 expression in the sheep fetus during late gestation.

Effect of a p210 multipeptide vaccine associated with imatinib or interferon in patients with chronic myeloid leukaemia and persistent residual disease: a multicentre observational trial

BACKGROUND

Although imatinib is the standard treatment for chronic myeloid leukaemia, not all patients reach complete cytogenetic remission (CCR) and most maintain detectable disease at the molecular level. We investigated whether a vaccine targeting the BCR-ABL-derived p210 fusion protein was an active and specific immunotherapy.

METHODS

We recruited 16 patients who had chronic myeloid leukaemia (with the b3a2 fusion point of p210), stable residual disease, a minimum treatment of 12 months of imatinib or 24 months of interferon alfa, and no further reduction of residual disease for at least 6 months preceding enrollment. They were given six vaccinations with a peptide vaccine derived from the sequence p210-b3a2 plus molgramostim and QS-21 as adjuvants (CMLVAX100) before assessment of immunological and disease response, which included detecting amounts of b3a2 transcripts by standardised quantitative real-time reverse-transcriptase PCR.

RESULTS

Of ten patients on imatinib, nine started CMLVAX100 having had a median of 10 months' stable cytogenetic disease (median 10% Philadelphia-chromosome-positive metaphases), whereas one started in stable CCR. All patients' cytogenetic responses improved after six vaccinations, with five reaching CCR. Notably, three of these five patients also had undetectable amounts of b3a2 transcript (BCR-ABL:beta2 microglobulin ratio <0.00001). Six patients on interferon alfa treatment with a median of 17 months' stable residual disease (median 13% Philadelphia-chromosome-positive cells) were also vaccinated. All but one had improved cytogenetic responses, and two reached CCR. Overall, we recorded peptide-specific delayed-type hypersensitivity (in 11 of 16 patients), CD4 cell proliferation (13 of 14 assessed), and interferon gamma production (five of five assessed).

INTERPRETATION

Addition of CMLVAX100 to conventional treatment in patients with chronic myeloid leukaemia might favour further reduction of residual disease and increase the number of patients reaching a molecular response.

Disseminated mucormycosis in a patient with acute myeloblastic leukemia misdiagnosed as infection by Enterococcus faecium

Mucormycosis is a rare complication in cancer patients. This report presents the case of a acute myeloblastic leukemia patient who developed an ascending paralysis due to disseminated mucormycosis. The presentation was unusual because the early symptoms were fever and pain, and the disease was misdiagnosed because of a concomitant infection by Enterococcus faecium.

Efficacy of anti-CD20 monoclonal antibodies (Mabthera) in patients with progressed hairy cell leukemia

BACKGROUND AND OBJECTIVES

Recently, a chimeric monoclonal antibody (MoAb) directed against the CD20 antigen (rituximab) has been successfully introduced in the treatment of several CD20-positive B-cell neoplasias and particularly of follicular lymphomas. Based on these premises we evaluated the efficacy and the toxicity of chimeric anti-CD20 monoclonal antibody (MoAb) in relapsed/progressed hairy cell leukemia (HCL).

DESIGN AND METHODS

Ten patients with relapsed/progressed HCL entered the study. Eight patients were males and two females with a median age of 55 years (range 41-78) and all of them had been previously treated with 2-chlorodeoxyadenosine and/or deoxycoformycin and a-interferon. Two out of 10 patients were anemic (Hb < 10 g/dL), 4 thrombocytopenic (Plt < 100 x 10(9)/L), 3 had fewer than 1.0 x 10(9)/L neutrophils and 3 had circulating hairy cells (HC). All patients received 375 mg/m2 i.v. of anti-CD20 MoAb once a week for 4 doses.

RESULTS

All patients were evaluable for response, one patient showing a complete remission and 4 a partial response. Adverse reactions, such as fever, chills, bone pain, hypotension and thrombocytopenia, were transient and mild (grade 1-2) and occurred only during the first course of treatment. One month after the last infusion, patients who had had anemia, neutropenia or thrombocytopenia, recovered normal peripheral blood values. Circulating HC also disappeared within one month. Immunostained bone marrow biopsies were checked 1, 3 and 6 months after the end of therapy and in 5 out of 10 patients a >50% reduction of bone marrow HC infiltration was recorded.

INTERPRETATION AND CONCLUSIONS

On the basis of these preliminary results observed in 10 patients with progressed HCL, it appears that treatment with anti-CD20 MoAb is safe and effective in at least 50% of patients, particularly in those with a less evident bone marrow infiltration (50%) and in those previously splenectomized.

Fossil Macaca remains from RDB quarry (Villafranca d'Asti, Italy): new data and overview

Mentioned in faunal lists since the late 1960s, Macaca remains from Villafranca d'Asti (early Villafranchian, Italy) were never described in detail. If some doubts were reported in the past about the related stratigraphic position, at present, partly thanks to the original acquisition labels, there is enough information to place these finds within the updated stratigraphic and biochronologic framework of the Villafranca d'Asti area. The reported sample consists of upper dentition and postcranial bones. By size and morphology all these remains are clearly Cercopithecinae, comparable with the extant Macaca sylvanus and mostly distinguishable from Mesopithecus, Dolichopithecus and Paradolichopithecus. The dental remains in particular give us the opportunity to discuss an inferred European size trend from smallest Pliocene macaques up to the larger living species M. sylvanus. Although Pliocene localities in western Europe have yielded so far only scanty Macaca finds, our data (even if preliminary) refute a major overall size difference between the extant Barbary macaque and the related fossil remains.

Simple and reliable high-performance liquid chromatography fluorimetric procedure for the determination of amphetamine-derived designer drugs

The paper describes a HPLC-fluorimetric procedure for the determination of methylenedioxyamphetamine, methylenedioxymethamphetamine, methylenedioxyethamphetamine and N-methyl-1-(1,3-benzodioxol-5-yl)-2-butanamine in urine, serum, saliva and street samples, that features interesting advantages over other procedures previously described. The method requires a very small sample volume (100 microl) and no extraction, lacks matrix effect, and is not time consuming. Linearity was in the range 50-1000 ng/ml regardless of matrix. Sensitivity and detection limit were 50 ng/ml and 10 ng/ml, respectively, but they may reach 10 ng/ml and 2 ng/ml if a slight modification is introduced in the procedure. Intra- and inter-day precision were always within 5% and 8%, respectively. Recovery was satisfactory for all matrices. The described procedure could be successfully used for clinical, epidemiological and forensic applications.

Prevention by (R)-alpha-methylhistamine of ethanol-induced gastric mucosal lesions in rats: importance of adherent mucus gel layer

The ability of (R)-alpha-methylhistamine, the selective agonist of histamine H3 receptors, to reduce ethanol-induced gastric damage was examined in the rat. (R)-alpha-methylhistamine (1-100 mg/kg intragastrically) caused a dose-related reduction in the amount of damage produced by ethanol. This protective effect was not shared by the S enantiomer of alpha-methylhistamine. Thioperamide, selective H3 receptor antagonist, inhibited the protective effect of 10 but not 100 mg/kg of (R)-alpha-methylhistamine. Pretreatment with (R)-alpha-methylhistamine, 100 mg/kg i.g., resulted in a significant increase in the thickness of adherent mucus gel layer, which may contribute to the protective action of the compound.

Blood pressure in nuns in a secluded order: A 30-year follow-up

The powerful effect of psychosocial and acculturating influences on population blood pressure trends seems to be confirmed, through longitudinal observations, in the nuns in a secluded order. After initial observations had been made on culture, body form, blood pressure, diet, and other variables in 144 nuns and 138 lay women, included as a control group, a 30-year follow-up study was undertaken. Most striking were opposite trends noted between the two groups in blood pressure trend. During the follow-up period, blood pressure remained remarkably stable among the nuns. None showed an increase in diastolic blood pressure over 90 mm Hg. By contrast, the control women showed the expected increase in blood pressure with age. This resulted in a gradually greater difference (delta>30/15 mm Hg) in systolic and diastolic blood pressure between the two groups, which was statistically significant. In addition, cardiovascular morbidity and mortality, expressed as the outcome of fatal and nonfatal events, were different in the two groups. They were significantly more common in the lay women than in the nuns. Comparisons between survival curves were statistically significant (p = 0.0043 for fatal events; p = 0.0056 for nonfatal events) between the two groups. In conclusion, it seems reasonable to attribute much of the difference in blood pressure and cardiovascular events, to the different burden in psychosocial factor and to the preserved peaceful lifestyle of the nuns.

[Partial liquid ventilation (PLV) in the newborn and infants: initial experiences in Italy]

Partial liquid ventilation is a valid alternative ventilation strategy for the management of the respiratory distress in newborn and infant. Authors describe their first experiences in 11 children (7 newborns, 4 infants).

Rapid onset of (R)-alpha-methylhistamine protection in response to ethanol-induced histologic damage in rat gastric mucosa

The influence of pretreatment with (R)-alpha-methylhistamine, selective agonist of histamine H3 receptors, has been investigated on gastric mucosal lesions at different time intervals, from 5 to 60 minutes, after administration of absolute ethanol in the rat. The amount and depth of lesions were quantitatively evaluated by light microscopy. In rats pretreated with (R)-alpha-methylhistamine, the integrity of the mucosa was preserved in approximately 80% of the total mucosal length measured despite ethanol challenge. Prevention of lesion formation was as great at 5 min after ethanol administration as at 60 min. When present, damage involved mainly superficial mucosa and lesions extending deeply into the gland region were evident in 1-2.5% of the total mucosa. Present findings indicate that mechanisms by which (R)-alpha-methylhistamine operates enable the mucosa to counteract damage just from the moment of exposure to ethanol and that protection is exerted both on surface and pit cells and on gastric glands.

Mitochondrial aspartate aminotransferase isoenzyme: a biochemical marker for the clinical management of alcoholics?

Serum mitochondrial and total aspartate aminotransferase activity was quantified by a characterized immunochemical method in 126 subjects, 44 healthy controls and 82 chronic alcoholics (51 outpatients and 31 monitored through 15 days). The monitored alcoholics were divided into actual abstinents (n = 21) and drinkers (n = 10) by blood ethanol concentration performed daily. The aims of the present study were: (a) to compare the diagnostic diagnostic usefulness of the mitochondrial isoenzyme and the mitochondrial/total aspartate aminotransferase ratio to detect problematic drinkers; (b) to evaluate the suitability of these indices to monitor abstinence, a difficulty not yet solved in the clinical management of alcoholics. The results demonstrated the mitochondrial isoenzyme to be more suitable to discriminate between controls and alcoholics (Kruskal and Wallis ANOVA, Bonferroni test, P < 10(-5) and mostly between actual drinkers and other alcoholics (P < 0.041). So acute alcohol consumption may be a significant, suggestive and until now inadequately examined factor in evaluating the suitability of mAST as a marker. The results, showing that mAST peaks quickly appear in the presence of a new alcohol intake, should indicate mAST as a possible marker of acute alcohol intake useful in checking self-claimed abstinence.

Carcinoma of the duodenum: management and survival in 14 cases

AIMS

The aim of this study is to evaluate the role of surgery in the treatment of adenocarcinoma of the duodenum.

METHODS

From 1955 to 1994, 14 patients with primary adenocarcinoma of the duodenum underwent surgical treatment in our department. Presenting signs and symptoms were mainly related to obstruction and bleeding. Upper gastrointestinal contrast study, Computed Tomography (CT) and duodenoscopy were the primary diagnostic procedure modalities. All diagnoses were confirmed histologically. The tumors were staged pathologically according to the new TNM classification (UICC, 1992). Eight patients received palliative treatment or exploratory laparotomy. The remaining 6 patients were resectable for cure.

RESULT

Operative mortality was 35.7%. The 5-year survival rate for patients who underwent curative resection was 33.3%. None of the patients who underwent palliative procedures or exploratory laparotomy survived for more than 11 months.

CONCLUSIONS

In the management of resectable adenocarcinomas of the duodenum surgical radicality including lymphadenectomy should be pursued. Unresectable adenocarcinomas treated with palliative procedure had a very poor prognosis.

Blood pressure trend and cardiovascular events in nuns in a secluded order: a 30-year follow-up study

30-year data are presented on blood pressure and cardiovascular morbidity and mortality for 144 nuns living in a secluded order in six nunnerlie in Umbria, central Italy and 138 lay women from the same region. There were no significant differences at baseline regarding age, blood pressure, body mass index, race, ethnic background, menarche, family history of hypertension or 24-hour urinary sodium excretion. None of the women were smokers and none took birth control pills nor did they use estrogen replacement therapy. During the observation period blood pressure remained remarkably stable among the nuns. None showed a rise in diastolic blood pressure to above 90 mm Hg. On the contrary the lay women showed the expected rise in blood pressure with age. This resulted in a gradually greater difference (delta > 30/15 mm Hg) in blood pressure between the two groups, which was statistically significant. There were 31 fatal and 69 non-fatal cardiovascular events during the 30 years of follow-up. These were significantly more common in the lay women, 10 vs. 21 fatal and 21 vs. 48 non-fatal in the nuns and lay women respectively. It appears reasonable to assume that the difference in psychosocial stress is the main underlying factor for the observed findings.

[The role of surgery in the treatment of primary carcinoma of the gallbladder. Review of 86 cases]

The records of 86 patients with primary adenocarcinoma of the gallbladder were reviewed. All patients were staged according to the Nevin classification. Twenty-nine patients underwent resection, 57 were submitted to palliative procedures or exploratory laparotomy. Survival was directly related to tumor staging and modality of treatment. The 5- and 10-year survival expectancy after curative resection was 46.8% in stage II patients, 14.2% and 0%, respectively, in stage V patients. None of the unresectable cases survived beyond 24 months, except for one patients who lived 62 months. No significant difference in survival expectancy was found between resectable and unresectable patients with stage V tumor.

[Perforated diverticulitis of the colon: modalities of the surgical treatment]

A retrospective study was carried on 66 patients surgically treated for perforated diverticular colonic disease: 22 had acute phlegmon or pericolic abscess and underwent primary resection and anastomosis. Of the remaining 44 patients, who had multiple pericolic and/or pelvic abscesses, or generalized peritonitis, in 30 cases the Hartmann procedure was used, 6 underwent Mikulicz operation, while drainage with proximal colostomy was performed in 5 cases, and simple suture and drainage in the last 3 cases. Operative mortality was 18.2%. Mortality rate was higher in patients treated by colostomy and drainage. The Hartmann procedure and resection-anastomosis patients had a mortality rate of 23.3% and 4.4% respectively. No mortality was registered among patients treated with suture and drainage.

Ethanol in biological fluids: headspace GC measurement

The present study evaluates the suitability of headspace gas chromatography (GC) with a capillary column as a method for determining the ethanol content in different biological fluids. This procedure allows the use of headspace GC not only as a reference method but also in routine diagnostics and monitoring work. The recent literature reviewed reports no standardized methodology that is at the same time suitable for ethanol determination in all routinely available biological fluids (blood, serum, plasma, urine, and saliva). The proposed procedure seems to be a good solution to the problem. The reproducibility study for the biological fluids tested resulted in coefficients of variation that ranged from 0.8 to 2.9% and recoveries that averaged 99%. Linearity was verified in the range of 0.01-20 g/L of ethanol in aqueous solutions. Sensitivity was determined to be 0.01 g/L. Ethanol measurement by this method is easy, simple, and highly reliable, and only a small sample volume (0.1 mL) is required. An internal standard and sample manipulation are not necessary. The obtained results suggest that the use of headspace GC could be extended from confirmatory analyses to routine application in many biomedical fields.

Thymostimulin effect on the immune response in pulmonary carcinoma with or without surgical treatment

Experience with 54 patients affected by pulmonary carcinoma treated or not with surgery and undergoing thymostimulin administration during long-term follow-up (70 mg i.m. every other day for 3 months), is reported. Drug intolerance was observed in 5.5% of cases. In patients who were able to complete the therapeutic cycle (50 cases) objective improvement of Performance Status was obtained in 46% of cases and subjective improvement in nearly 90%. The course of neoplastic disease showed definite progression (presence of local recurrence or distant metastasis) in 20% of cases, remission in 6%. No case of onset of pulmonary or extrapulmonary infections was observed. After treatment, a significant increase (between 24% and 108%) in blood parameters (circulation lymphocytes, CD3, CD4, CD8, CD16, IgG, IgA, IgM) was observed in 28-56% of cases. As for CD4 increase, this was accompanied by concomitantly positive Merieaux test in 44.5% of cases. Quiescence or complete remission has appeared to occur together with high CD16 values, progression with high CD8 and low CD16 values.

Thymostimulin effect on the immune response in neoplastic patients submitted to surgical treatment

We selected the data from performance status, disease state, skin tests, circulating lymphocytes and relative subsets, serum immunoglobulin classes to evaluate the immune response in 29 neoplastic patients treated with surgery and undergoing Thymostimulin administration during long term follow-up. Moderate drug intolerance was observed in 3 patients. After treatment lymphocyte count increase (41% mean increase) in 61.5% of cases; CD3, CD4, CD8, CD16 respectively 95-74-87-82% of cases; immunoglobulin classes in about 90% of cases. A clear-cut improvement of Karnofsky's index was observed in 34.6% of cases, worsening in 11.5%. A manifest improvement in the delayed hypersensitivity skin test resulted in 36% of cases. Most patients (85%) have shown signs of complete disease remission. Disease progression was observed only in 3 patients. There were no infections during this study.

Role of surgery in ductal carcinoma of the pancreas

Data of 111 patients with ductal carcinoma of the pancreas examined over a decade (1979-1989) at the 1st Department of Surgery, "La Sapienza" University of Rome, are presented. 21.6% of them underwent pancreatic resection and 40.5% biliodigestive diversion. Resectability was 26.5% for tumors of the head, 11.8% for tumors of the body and tail, nil for diffuse tumors. Overall operative mortality was 13.5%. Only stage I patients were shown to be resectable for cure and benefited from surgery with 21% probability of 5-year survival.

The spectrum of cardiovascular abnormalities in autosomal dominant polycystic kidney disease: a 10-year follow-up in a five-generation kindred

Clinical, electrocardiographic and echocardiographic data were collected in a group of 228 patients with autosomal dominant polycystic kidney disease (PKD) and in another group of 146 unaffected members (NPKD) both comprised in a five-generation kindred followed for 10 years, in order to determine the profile and prevalence of cardiovascular derangement of the genetic disease. A family of 181 members was used as a control. The prevalence of left ventricular hypertrophy in the three groups was 24, 14 and 6% respectively (p less than 0.01); after 10 years it increased up to 35, 26 and 13% respectively (p less than 0.05). The evidence of mitral-valve prolapse was more frequent in PKD and in NPKD group (25 and 20% respectively) than in control subjects (2%) (p less than 0.0001). Mitral incompetence was found in 30, 18 and 8% of those groups respectively (p less than 0.002). The large difference in mitral involvement did not change over time. Tricuspid valve prolapse was detected in 5, 4 and 1% of the three groups, respectively (p less than 0.05). A small increase in frequency was found after 10 years only in polycystic kidney disease patients. Regurgitant aortic lesions were present in higher prevalence in PKD (19%) and NPKD (17%) members than in controls (5%) (p less than 0.001). After 10 years they were 23, 20 and 8%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Time-course study of blood pressure over a 20-year period in congenital blindness

In a prospective study blood pressure was recorded for 20 years in 132 white patients with congenital blindness and in 138 white control schoolchildren. The subjects for both groups were consecutively enrolled without any selection parameters. During the study period a similar proportion of blind patients and controls reported identical consumption of tobacco (above the age of 14 years) and of oral contraceptives (above 21 years) among women. Mean 24-h urinary sodium excretion, collected randomly in both groups, did not differ between the blind patients and the controls. During the 20-year period systolic and diastolic blood pressure rose with age in the control group as expected and much less in blind patients; after 14-17 years the difference was statistically significant. The mean slope of the regression line (beta coefficient) for systolic blood pressure versus age was 1.143 in the blind patients and 1.794 in the controls (P less than 0.001), and for diastolic blood pressure 0.908 in the patients and 1.353 in the school children (P less than 0.001). The mean weight and body mass index increased more in the blind patients than in the controls (difference 5.9 and 2.8 kg, respectively). The results support the hypothesis that low visual and cognitive stress levels determine a lower level of cardiovascular reactivity with ageing.

Age and blood pressure changes. A 20-year follow-up study in nuns in a secluded order

In a prospective study, 144 white nuns belonging to a secluded monastic order and 138 white control laywomen were followed for 20 years to investigate whether living for a long time in a stress-free environment influences the effect of aging on blood pressure. Silence, meditation, and isolation from society are the distinctive features of the life-style examined. At study entry, blood pressure was not dissimilar in the nuns and the control group, but it increased over time only in the controls, with a mean slope of the regression line (beta coefficient) of 0.089 in the nuns (NS) and 2.171 in the controls (p less than 0.0001) for systolic blood pressure and of 0.054 in the nuns (NS) and 0.742 in the controls (p less than 0.0001) for diastolic blood pressure. Weight and body mass index increased similarly over time in the two groups. Family history of hypertension was not dissimilar between the groups. Serum cholesterol and triglycerides, higher at study entry in the nuns, increased similarly over time in the two groups. Twenty-four-hour urinary sodium excretion, collected randomly in both groups, did not differ over time between nuns and controls. None of the women smoked or used oral contraceptives. Educational level was higher in the control group, but subgroups of 48 nuns and 52 laywomen of comparable educational level maintained the same difference in the blood pressure trend over time as in the main cohort. Parity affected the increase of systolic, but not of diastolic, blood pressure with age among the laywomen, but nuns and no-childbirth controls maintained a significantly different blood pressure trend over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic value of brainstem auditory evoked potentials in pediatric patients with traumatic coma

This paper studies the auditory evoked potentials of the brainstem (BAEPs) in 30 pediatric patients with serious head trauma admitted to a particular hospital. The results have shown the importance of BAEPs especially in those patients whose prognoses are uncertain.

Blood pressure changes over 20 years in nuns in a secluded order

Blood pressure was recorded for 20 years in 138 nuns in a secluded order and in 126 lay women taken as controls. During the study period none of the nuns or control women smoked, took oral contraceptives or changed residence. Diet was unrestricted and comparable in the two groups. Subjects of both groups were consecutively enrolled without any selection parameters. During the 20 years of observation, systolic and diastolic blood pressure rose with age in the control women but remained almost unchanged in the nuns. The mean of the regression slope of systolic and diastolic blood pressure versus age, which was calculated for each subject, was 0.089 and 0.054 respectively in the nuns, as opposed to 2.171 and 0.742 in the lay women (both P < 0.001). Secluded nuns, who spend almost all their time in silence and prayer in the virtual absence of company apart from when attending religious celebrations, thus showed almost no change in blood pressure with age over a 20-year period. The results support the hypothesis that, at least in women, everyday stress may be a determinant of the progressive increase in blood pressure with ageing.

Free adrenaline and noradrenaline excretion related to occupational stress

Urinary levels of free adrenaline and noradrenaline were measured in two groups of healthy male industrial workers exposed to alternate four-day periods of working conditions with and without time stress, to test the hypothesis that the sympathetic nervous system is overactivated by occupational stress. Thirty confectionary workers alternated piece-work (payment by results) and work with a fixed daily wage while 30 metal workers alternated work on an assembly line with work off it. Under time stress urinary free adrenaline was 450 per cent and noradrenaline 230 per cent of the levels for similar work without time stress but involving equal oxygen consumption. These differences were statistically highly significant and they persisted on retesting after six months of alternating work regimens. They support the concept that occupational stress in industrial workers influences the adrenosympathetic system and they indicate a possible method for assessing the effects of high levels of sympathetic activity on the aetiology of ischaemic heart disease.