CTA and DSA Evaluation of Patients with Subarachnoid Haemorrhage

We correlate digital subtraction angiography (DSA) and computed tomography with angiographic 3D reconstruction (CTA) in patients with subarachnoid haemorrhage. 45 patients were evaluated with both techniques (CTA and DSA) within 3–4 days after acute haemorrhage: source CT images, MIP and 4D-angio reconstruction and standard DSA were performed and correlated. The MIP tecnique is very easy and quick to perform and operator independent, while 4D-angio reconstruction requires at least 30 minutes to obtain good quality images.

CTA and DSA were equivalent in demonstrating the presence of all 57 aneurysms in the 45 patients. Most aneurysms were located at the level of the circle of Willis; CTA was not adequate to demonstrate the neck of aneurysms in 7 cases located in of the syphon, vertebral artery and posterior communicating artery; CTA gave a good display of the thrombus within the aneurysm.

Patients could go directly from the CT diagnostic room to the operating room in certain types of aneurysm such as those in the anterior communicating artery or middle cerebral artery in which there is a correlation between site of the haemorrhage and the aneurysm. In the future, improvements in MR technology will also exclude aneurysms in sites difficult to evaluate by CTA such as the syphon, so that DSA will be performed only in selected doubtful cases.

Effect of nerve growth factor on cultured human chondrocytes

Nerve growth factor (NGF) is involved in several joint diseases. It participates in nociception and neurogenic inflammation and its concentrations increase in synovial fluid and tissue from arthritis. However, data about its role in articular cartilage are scant and conflicting. This study analysed effects of different NGF concentrations on cultured human chondrocytes by evaluating cell proliferation, cell phenotype, and gene expression. The MTT test excluded an influence on cell viability. Alcian blue and S100 staining demonstrated that NGF may induce de-differentiation of the chondrocyte phenotype. Real-time PCR showed that NGF did not influence gene expression of type I, II and XI collagen, TGF-β, IGF-1 and metalloproteinase (MMP)-13, while it reduced the expression of MMP-3. These findings show that NGF may have uncertain effects in human chondrocytes. Further investigations by wider gene expression and protein synthesis analyses are required to determine how chondrocytes may be influenced by NGF.

Alterazioni meningee da ipotensione liquorale essenziale

Gli autori descrivono un caso di ipotensione liquorale essenziale con sindrome clinica ad esordio acuto, costituita da cefalea gravativa che si riduceva parzialmente in decubito orizzontale, regredita in cinque mesi. Vari esami RM dimostrarono la presenza di un ispessimento durale con accentuazione dopo contrasto, sia in sede endocranica che a livello cervicale, ed anche un sottile e circoscritto scollamento durale con lievi fenomeni emorragici; alla remissione clinica si accompagnò la normalizzazione del quadro neuroradiologico. Vengono discussi i possibili meccanismi patogenetici delle alterazioni durali alla luce dell'anatomia degli strati profondi della dura e ne vengono sottolineati gli aspetti radiologici.

Potential Markers of Tongue Tumor Progression Selected by cDNA Micro Array

Squamous cell carcinoma (SCC), the most frequent malignant tumor of the oral cavity, generally exhibits a poor prognosis and metastases are the main cause of death. This tumor often arises from pre-malignant lesions. To date, it is difficult to predict if and which pre-malignant lesions may progress into oral SCC using traditional methods. For these reasons, several studies are trying to identify markers useful in the progression of pre-malignant lesions and tumors. To define the genetic expression profile of tongue tumor progression we compared 9 dysplasias (DS), 8 tumors without metastasis (TWM), 11 metastasizing SCCs (MT) of the tongue, and a baseline of 11 normal tissues by using cDNA microarray containing 19.2 K clones. We initially applied hierarchical agglomerative clustering based on information from all 6026 clones. Results were obtained by performing a two steps analysis: a Significance Analysis of Microarray (SAM) and a Gene Ontology search. One hundred and five clones have statistically significant different expression levels (FDR <0.01) between DS and TWM, whereas 570 genes have statistically significant difference expression levels between TWM and MT (FDR <0.01) as detected by SAM. By filtering with FatiGo only 33 genes were differentially expressed in TWN, respect to DS, whereas 155 genes were differentially expressed in MT respect to TWM. We detected some genes which encode for oncogenes, transcription factors and cell cycle regulators as potential markers of DS progression. Examples are BAG4, PAX3 and CCNI, respectively. Among potential markers of metastases are some genes related to cell mobility (TSPAN-2 and SNTA1), intercellular adhesion (integrin alpha 7) or extracellular matrix components (ADAMTS2 and cathepsin O). Additionally, under-expressed genes encoded apoptosis-related proteins (PDCD4 and CASP4). In conclusion, we identified several genes differentially expressed in tumor progression which can potentially help in better classifying premalignant lesions and tongue SCCs.

Bacterial load of periodontal pathogens among italian patients with chronic periodontitis: a comparative study of three different areas

The aim of the present study was to evaluate the mean bacterial load of some periodontal pathogenic bacteria in Italian patients affected by chronic periodontitis. The sample consisted of 1,762 patients with a clinical diagnosis of chronic periodontitis based on the criteria of the American Academy of Periodontology sampled in the period 2013-2015; 1,323 patients were from Northern Italy, 317 from Central Italy and 122 from Southern Italy. Samples for microbiological analysis were collected from the four sites of the greatest probing depth in each patient and then processed by quantitative polymerase chain reaction. Periodontal pathogens have the following percentage respect to total bacteria load: Aggregatibacter actinomycetemcomitans 0.1%, Campylobacter rectus 2%, Fusobacterium nucleatum 8%, Porphyromonas gingivalis 6%, Treponema denticola 2% and Tannerella forsythia 1.5%. There are significant differences in bacterial load among the different geographical areas both for the total bacterial and for the single species. The results of our study in this Italian population showed that a different geographic distribution exists among periodontal pathogens. We hypothesize that these differences in bacterial load could be related to genetic and environmental factors. Additional studies are necessary to confirm these data and to get more insight on additional factors, which may play a role in periodontal pathogens in different geographic areas.

Evaluation of the efficacy of a new oral gel as an adjunct to home oral hygiene in the management of chronic periodontitis. A microbiological study using PCR analysis

The use of chemical devices for non-surgical periodontal therapy has led to new treatment strategies aiming primarily at infection control and oral bacterial load. Over the last few decades adjunctive chemical devices has been subjected to many scientific and medical studies. The purpose of the present study was to assess the effect of a new oral gel named Parodongel on the red complex organisms using Polymerase Chain Reaction (PCR) for microbiological analysis. A total of 10 patients with a diagnosis of chronic periodontitis in the age group >25 years, were selected. None of these patients had received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. Four non-adjacent sites in separate quadrants were selected in each patient for monitoring based on criteria that the sites will localize chronic periodontitis. Microbial analysis (MA) was performed at baseline and at day 15. Paired T-Test was used to detect statistical significant reduction of specific bacteria. The results showed statistically significant reduction of the overall bacterial loading and Treponema Denticola from baseline to day 15. Parodongel can be used as an effective local drug delivery together with oral home care in treatment of chronic periodontitis.

Bio-Revitalization: Effects of NASHA on Genes Involving Tissue Remodeling

BACKGROUND

The "non-animal stabilized hyaluronic acid" (NASHA) is a widely used product in bio-revitalization injective procedures in esthetic medicine. The present research aimed to quantitatively evaluate the therapeutic effect of one of the more used bio-revitalization products on cultured dermal fibroblasts. RT-PCR was used for gene expression profiling of some proteins known to be relevant in skin homeostasis.

METHODS

Human dermal fibroblasts were seeded on a culture medium enriched with a product for dermal bio-revitalization, consisting of stabilized hyaluronic acid gel 20 mg/ml. After 24, 48, and 72 h of exposure, the cDNA was amplified by real-time PCR. Gene expression was quantified with the delta/delta calculation method.

RESULTS

In this study, the gene of metalloproteinase (MMP)-13 is strongly expressed after NASHA incubation. The MMP-2 encoding gene instead is less expressed, but both evidence the same temporal trend, being progressively up-regulated after 24 and 48 h, thereafter the expression decreases, whereas MMP-3 maintains the same up-regulation at 72 h. Hyaluronan synthase 1 and desmoplakin are progressively up-regulated and increase at 24, 48, and 72 h. Hyaluronidase 1 and neutrophil elastase genes are overexpressed, but at 72 h they both exhibit the same behavior as the other degradative enzymes MMP-13 and MMP-2.

CONCLUSIONS

Skin bio-revitalization by injecting the tested NASHA gel produces an enhancement in the expression of some genes involved in extracellular matrix degradation and organization. In this study, a time-dependent behavior, different for genes encoding degradative compared to synthesis proteins, was demonstrated.

INSULIN ACTIVITY ON DENTAL PULP STEM CELL DIFFERENTIATION: AN IN VITRO STUDY

Insulin is a powerful and important hormone involved in the proliferation and differentiation of osteoblasts. Dental pulp stem cells (DPSCs) have the ability to self-expand and differentiate in pre-osteoblast, producing in vitro autologous bone tissue. The aim of our study is to investigate whether insulin can influence differentiation of DPSCs in osteoblast and bone tissue. Dental germ pulp was extracted from third molars of healthy subjects, following informed consent. DPSCs were treated with insulin at the concentration of 100 ng/μl for 24 and 48 h. Gene expression in treated DPSCs was compared with untreated cells (control) in order to check the effect of insulin on stem cell differentiation. After 24 h, significant up-regulated genes (Fold change > 2) in DPSCs were the Bone Morphogenetic Proteins BMP3, BMP4 and their receptor BMPR1A. BMP1 results over-expressed after 48 h of treatment. Significantly down-regulated genes were BMP4, BMP7 and TGFBR2 after 24 h of treatment and BMP5 and BMP7 after 48 h. Insulin was demonstrated to influence proliferation of DPSC, differentiation and expansion in osteoblasts. Further studies are needed to explore this new way of creating bone tissue.

HYALURONIC ACID IN DERMAL REJUVENATION: AN IN VITRO STUDY

The purpose of this paper is to evaluate the role of hyaluronic acid in bio-revitalization by testing several extracellular matrix biological parameters in cultured dermal fibroblasts. To this aim, fibroblastic expressed genes after exposition to three hyaluronic acid medical devices were evaluated. Cells were seeded on a layer of three different medical devices containing 6.2, 10 and 20 mg/ml of hyaluronic acid for 24 h. Real Time Polymerase Chain Reaction was performed to investigate gene expressions. Genes encoding hyaluronic acid synthesis and degradation, Metalloproteinases 2 and 3 and Desmoplakin production as well as GDF6, and IGF1 were activated by hyaluronic acid products. The in vitro study showed similar effects on tested genes despite a different concentration of hyaluronic acid contained in the medical devices and the simultaneous presence of other additives. Based on the reported data, gene activations are an aspect of metabolic modulation of signalling pathways rather than the proportional production of a specific connective tissue molecule. Indeed different hyaluronic acid concentration and the presence of other additives did not change the overall effect on the studied genes. We believe that the optimization of extracellular matrix micro-environment, obtained by enhanced structural support with hyaluronic acid, leads to functional and metabolic improvement.

HYALURONIC ACID: THE USE OF ITS PRECURSOR IN SKIN BIO-STIMULATION

Bio-stimulation is an injective therapy aimed to boost the anabolic functions of dermal fibroblasts to obtain skin improvement. It can be achieved with multiple intradermal injections (0.05–0.1 ml each) of a solution of 400 mg (3 ml) of injectable glucosamine sulphate, plus 5.623 mg (3 ml) of polideoxyribonucleotide, 1 ml of lidocaine and 0.5–1 ml of sodium bicarbonate, to repeat every 7, 14, 21, and 28 days. The administration of glucosamine sulphate to skin fibroblasts is believed to lead to its incorporation in glycosaminoglycans, and thereby to the stimulation of extracellular matrix synthesis, whereas polideoxyribonucleotide possesses anti-inflammatory and regenerative capability. This study aims to elucidate the in-vitro effects of this treatment by studying what happens to several genes related to connective tissue integrity. Human dermal fibroblasts were seeded in a culture medium enriched with either two drugs alone or combined: glucosamine sulphate and/or polideoxyribonucleotide. After the end of the exposure time of 24 h, 48 h, and 72 h, the cells were trypsinized and lysed for RNA extraction. Reverse transcription to cDNA was performed directly from cultured cell lysate. Finally, the cDNA was amplified by real-time PCR and a panel of genes involved in dermal integrity was tested. Gene expression of Hyaluronan synthase 1 (HAS1), Elastine (ELN), Insulin like growth factor 1 (IGF1), Growth differentiation factor 6 (GDF6) and of a series of catabolic enzymes, such as Metalloproteases (MMP) 2, 3 and 13, the neutrophyl expressed Elastase (ELANE) and the Hyaluronidase 1 (HYAL1) were tested after 24, 48 and 72 hours of exposure to glucosamine sulphate and polideoxyribonucleotide alone or combined. All the tested genes but one were up-regulated. A negative synergism on several enzymes (particularly appreciable for Insulin-like growth factor 1 and metalloprotease 13) was observed when the two drugs were delivered together. Glucosamine sulphate acts not only as building block in the biosynthesis of glycosaminoglycan chains, but also as a booster of hyaluronan synthase 1. The association of glucosamine sulphate and polideoxyribonucleotide, used in bio-stimulation therapy protocol, has a negative synergism on catabolic genes in dermal fibroblast cultures. The present observations produce further insight into the effects of glucosamine sulphate in the biosynthesis of glycosaminoglycan chains.

EFFECT OF SOMATOSTATIN ON DENTAL PULP STEM CELLS

Dental pulp stem cells (DPSCs) are multipotent stem cells with the potential to differentiate into various cell types. For this reason, they have been proposed as an alternative source for mesenchymal stem cells. Somatostatin is a peptide hormone with an inhibitory effect on several endogenous hormones. The aim of our study is to investigate whether somatostatin can promote or inhibit differentiation of DPSCs in osteoblasts and bone tissue. DPSCs were extracted from third molars of healthy subjects, and were treated with somatostatin at the concentration of 100 ng/ml for 24 and 48 h. Gene expression in treated DPSCs was compared with untreated cells (control) in order to check the effect of somatostatin on stem cell differentiation. After 24 h of treatment many genes investigated were down-regulated in treated DPSCs vs untreated DPSCs. Significantly up-regulated gene (Fold change > 2) was the Bone Morphogenetic Protein BMP4. On the contrary somatostatin induced the over-expression of bone related genes after 48 h of treatment (i.e. BMPR1B and BMPR2). TGFB family genes and their receptors were also significantly up-regulated after 48 h of treatment. Somatostatin demonstrated to promote the self-renewal of DPSCs: in our experiments somatostatin mainly acted on TGFB family genes. Further studies are needed to explore this new way of creating bone tissue.

CDH1 POLYMORPHISMS AND LOW EXPRESSION OF E-CADHERIN AND β-CATENIN IN COLORECTAL CANCER PATIENTS

Epithelial-mesenchymal transition (EMT) process has a central role in tumor progression and metastases. Loss of cell-to-cell adhesiveness is a key step in EMT. In particular, E-cadherin and β-catenin, components of the adherens junctions, play a strategic role. Accumulation of β-catenin at cytoplasmic level following adherens junctions disruption, induces its translocation into the nucleus, where it binds to members of the TCF/LEF family of transcription factors. In particular, Lymphoid Enhancer-Binding factor 1 (LEF1) product can target genes involved in EMT. The aim of the present study was to evaluate the influence of CDH1 and CTNNB1 genes, coding for E-cadherin and β-catenin respectively and LEF1 in a sample study of 140 Italian patients affected by colorectal cancer. An association study between four single nucleotide polymorphisms (rs11865026, rs11642413, rs13689, and rs10431923) of CDH1 and the disease did not provide statistically significant results. The gene expression analysis carried out for CDH1, CTNNB1 and LEF1 in 54 paired specimens from 27 patients provided evidence of a reduced expression of the first two in cancer tissues. We believe there may be a sort of cross regulation between the products of these two genes which closely interact in EMT activation and that such hypothesis should be further investigated in a greater number of cases.

E-CADHERIN CODING GENE (CDH1) AND NONSYNDROMIC CLEFT LIP WITH OR WITHOUT CLEFT PALATE: IS THERE ANY ASSOCIATION?

Epithelial to Mesenchymal Transition (EMT) is an important process involved in cancer, embryogenesis and organ development. Its role in nonsyndromic cleft lip with or without cleft palate (NSCL/P) has been extensively investigated and successfully linked to the disease. In this study, we focused on a gene, CDH1, encoding for E-cadherin, a key protein in EMT. We carried out an association study on an Italian sample group, genotyping four single nucleotide variations within the CDH1 gene, in order to verify the potential role of this gene in NSCL/P etiology. Neither the haplotype nor the family-based association test revealed any association between the genotyped SNPs and the pathology. Our results demonstrate that, in our Italian sample study, the analyzed single nucleotide polymorphisms are not associated to NSCL/P.

QUANTITATIVE ANALYSIS OF PERIODONTAL PATHOGENS IN PERIODONTITIS AND GINGIVITIS

Periodontal tissues surround the teeth and provide their attachment. Periodontal diseases include a mild and reversible form named gingivitis and periodontitis that is the main cause of tooth loss in adults. Gingivitis, that affects gums and coronal junctional epithelium, as well as periodontitis, that is characterized by loss of connective tissue attachment, are caused by a persistent inflammatory response promoted by alteration of periodontal biofilm. The aim of the study was to test whether the prevalence or relative amount of each species was associated with a particular clinical condition. Periodontal evaluation of 539 unrelated patients was performed by the Periodontal Screening and Recording (PSR) system. Subgingival samples were obtained from the site with the worst PSR score. A selection of eleven bacterial species was evaluated by quantitative real time PCR. Some bacterial species were found to be associated with all phases of periodontal disease, such as Tannerella forsythia, Treponema denticola, and Treponema lecithinolyticum, while other species were more specifically associated with periodontitis, such as Porphyromonas endodontalis and Porphyromonas gingivalis, or with gingivitis, such as Capnocytophaga ochracea and Campylobacter rectus. Quantitative and qualitative analyses helps to better understand the microbial changes associated with different stages of periodontal disease.

INTERLEUKIN-6 GENE POLYMORPHISM MODULATES THE RISK OF PERIODONTAL DISEASES

Gingivitis and periodontitis are the two main periodontal diseases. Both are characterized by inflammation of the tissues surrounding the teeth but while tissue damages observed in gingivitis are mild and reversible, destruction caused by periodontitis is deeper and irreversible. Periodontal diseases and levels of degeneration of tissues surrounding teeth depend on several interacting endogenous and exogenous factors. Polymorphisms of genes encoding molecules that modulate the immune response and tissue homeostasis are the main causes of individual susceptibility to periodontal diseases. The aim of this study was to investigate IL6, IL10 and VDR gene polymorphisms in a large number of subjects affected by either gingivitis or chronic periodontitis. The sample included 750 Italian patients. We found that the rs1800795 SNP located in the IL6 gene promoter was strongly associated with the occurrence of both gingivitis and periodontitis. Indeed, homozygous individuals with variant allele appeared less-susceptible to both gingivitis OR=0.47 (95% C.I. 0.27-0.82) and periodontitis OR=0.36 (95% C.I. 0.21-0.64). No evidence of association between periodontal diseases and IL10 or VDR polymorphisms was obtained. This data confirmed the role of IL6 in susceptibility to periodontitis among the Italian population. The evidence that IL6 polymorphisms are also involved in gingivitis has implications in periodontal disease pathogenesis and reduces the appeal of IL6 as a periodontitis biomarker.

Gene expression of human osteoblasts cells on chemically treated surfaces of Ti-6Al-4V-ELI

Surface modifications of titanium alloys are useful methods to enhance the biological stability of intraosseous implants and to promote a well succeeded osseointegration in the early stages of implantation. This work aims to investigate the influence of chemically modified surfaces of Ti-6Al-4V-ELI (extra-low interstitial) on the gene expression of human osteoblastic (HOb) cells. The surface treatments by acid etching or acid etching plus alkaline treatment were carried out to modify the topography, effective area, contact angle and chemical composition of the samples. The surface morphology was investigated using: scanning electron microscopy (SEM) and confocal laser-scanning microscope (CLSM). Roughness measurements and effective surface area were obtained using the CLSM. Surface composition was analysed by energy dispersive X-ray spectroscopy (EDX) and by X-Ray Diffraction (XRD). The expression levels of some bone related genes (ALPL, COL1A1, COL3A1, SPP1, RUNX2, and SPARC) were analysed using real-time Reverse Transcription Polymerase Chain Reaction (real-time RT-PCR). The results showed that all the chemical modifications studied in this work influenced the surface morphology, wettability, roughness, effective area and gene expression of human osteoblasts. Acid phosphoric combined to alkaline treatment presented a more accelerated gene expression after 7days while the only phosphoric etching or chloride etching combined to alkaline treatment presented more effective responses after 15days.

Effects of glucosamine and nucleotide association on fibroblast: extracellular matrix gene expression

Glucosamine (Gluc) is a drug used as an anti-inflammatory in moderate forms of knee arthrosis. A further off label use of Gluc is in the anti-aging treatments associated with Polideoxirybonucleotide (PDRN) through intra-dermal injection for a procedure called bio-stimulation. An unexpected effect on cultured dermal fibroblasts, during an experimental study on the gene activation in aesthetic bio-stimulation, was observed. The results have potential application in orthopaedic medical therapy. Fibroblast primary cultures were carried out, seeding cells on a layer of Gluc or PDRN alone or in combination for 24 h. Real Time-PCR was performed to investigate several gene expressions. The MMP13 and the IGF-I gene expression in fibroblast cultures were strongly inhibited after 24 h of incubation with the association of Gluc and PDRN, whereas Gluc and PDRN alone produced a modest inhibition of IGF-I and an activation of MMP13. MMP13 is present in osteoarthritic cartilage and this enzyme plays a significant role in cartilage collagen degradation. IGF1 is involved in growth and development and is successfully used in tissue-engineering for cartilage repair. Based on the reported data, we infer that the association of Gluc and PDRN has a potential application in cartilage therapy. Additional basic science and clinical studies are needed to confirm this preliminary report.

Adipose derived stem cells: basic science fundaments and clinical application. An update

Soft tissues regeneration can be used to treat several kinds of diseases including congenital and post traumatic deformities, and to fill out tissue depression due to orbital and periorbital surgery, scars or cancer resections. Generally it is performed by the use of autologous tissue flaps, alloplastic implants and autologous fat grafting. All of these methods have several disadvantages, which include resorption of the autologous material, foreign body reaction and implant migration. Stem cell application has been suggested as a possible novel therapy for regenerative medicine thanks to their unlimited capacity of self-renewal, as well as the property to differentiate into multiple cell types under appropriate stimuli. This short review describe the recent development in stem cells isolation, expansion and characterization and their employment in tissue regeneration and tissue engineering.

Calcium sulfate stimulates pulp stem cells towards osteoblasts differentiation

Calcium sulfate (CaS) is a highly biocompatible material and enhances bone formation in vivo. However, how CaS alters osteoblast activity to promote bone formation is poorly understood. To study how CaS can induce osteoblast differentiation in mesenchymal stem cells, the expression levels of bone related genes and mesenchymal stem cells marker were compared in normal osteoblasts and dental pulp stem cells, using real time Reverse Transcription-Polymerase Chain Reaction. Gene differentially expressed between the two cells type were the trascriptional factor RUNX2, osteopontin (SPP1), COL1A1 (collagen type 1α1) and alkaline phosphatase (ALPL). The obtained results demonstrated that CaS strongly influences the behavior of DPSCs in vitro enhancing proliferation, differentiation and deposition of matrix.

Study of ABCB1 multidrug resistance protein in a common orofacial malformation

The onset of embryonic malformations is greatly determined by the intrauterine environment, conditioned by maternal lifestyle, diet, drugs and medication intake, in addition to both foetal and maternal genotypes. Maternal C677T MTHFR genotype has been identified as important factor in cleft lip with or without cleft palate (CL/P) etiology. In the present study we evaluated the possible interaction between maternal methylenetetrahydrofolate reductase (MTHFR) and foetal ABCB1 genotypes. ABCB1 gene codes for a drug-transport pump in charge to protect the cell by extruding a variety of harmful exogens, but with a reduced activity in a folate-restricted condition. Maternal 677T genotype is translated in a reduced folate availability for the developing embryo who consequently may becomes more exposed to external insults. A family based association analysis was performed to test the effect of ABCB1 polymorphisms in clefting, in the whole sample and in the stratified sample accordingly to maternal MTHFR genotype. No evidence of association between ABCB1 polymorphisms and CL/P was detected. This suggests that ABCB1 or ABCB1-MTHFR feto-maternal interaction could have no effect in orofacial clefting or could play a role in a limited number of cases.

Estimation of the Serial Interval for Pandemic Influenza (pH1N1) in the Most Southern Province of Argentina

BACKGROUND

A retrospective cohort study, in the context of household transmission, to estimate the serial interval (SI) of pH1N1 influenza in the island of Tierra del Fuego was carried out.

METHODS

We collected data from the epidemiological surveillance system during disease outbreak in Ushuaia and Rio Grande, the two main cities of the southernmost province of Argentina. Only the records of patients and households with a positive result of RT-PCR assay for pH1N1 virus were used.

RESULTS

A total of 283 laboratory confirmed cases were detected, from 550 samples analyzed. Hospitalizations were necessary in 13.8% of patients, yet no deaths were reported. Complete data of household contacts were available in 13 patients. We calculated an SI of 2.0 days (95% CI = 1.5 - 2.6 days), fitting to a log-normal distribution, the one that presented the best adjustment.

CONCLUSION

These results were consistent with estimates of SI calculated from Mexico, but lower than estimations from Canada, Germany and USA. We discuss these differences in relation to limitations of the current study design.

CAG repeat length in androgen receptor gene is not associated with amyotrophic lateral sclerosis

BACKGROUND

Epidemiological and clinical studies show higher prevalence of amyotrophic lateral sclerosis (ALS) in males than in females and more severe lesions in androgen receptor (AR)-expressing tissues. The AR gene contains a polymorphic CAG trinucleotide repeat, whose expansion over a certain threshold is toxic to motor neurons, causing spinal and bulbar muscular atrophy (SBMA).

PURPOSE AND METHODS

We tested the hypothesis that the AR CAG repeat linked to SBMA is a risk factor for ALS. We analyzed AR CAG expansions in 336 patients with ALS and 100 controls.

RESULTS

We found a negative association of AR CAG expansions with ALS susceptibility, clinical presentation, and survival.

CONCLUSIONS

Our findings do not support a role of the AR CAG repeat length in ALS.

Comparative analysis between nasolabial and island pedicle flaps in the ala nose reconstruction. Prospective study

The goals of reconstructing deformities of the face secondary to skin cancer include reconstructing the area with similar tissue. The comparison between different types of local flaps for reconstruction of nasal ala is presented in a prospective, randomized study. The objective of this study was to compare the functional and esthetic outcomes between the nasolabial and island flaps. A total of 60 patients with skin cancer of the nose underwent ala reconstruction: 30 cases by nasolabial flap (group A) and 30 by island flap (group B). The two groups were homogeneous for sex, age, and anatomical area. Complications, scarring according to the scale of Vancouver, cosmetic appearance, and disorders of sensations were analyzed and statistical analysis was performed. In group A, early complications were more common than in group B. The scars of group B patients were more like those of undamaged skin. A total of 10% patients of group A evaluated the cosmetic appearance of their nose as very good, while in group B, 30% patients gave such an evaluation. Local flaps provide better reconstruction and the island flap appears to have more efficacy when compared with nasolabial flap for nasal ala reconstruction.

Gene expression profile of human colon cancer cells treated with cross-reacting material 197, a diphtheria toxin non-toxic mutant

Cross-Reacting Material 197 (CRM197) is a diphtheria toxin non-toxic mutant that has shown antitumor activity in mice and humans. It is still unclear whether this anti-tumorigenic effect depends on its strong inflammatory-immunological property, its ability to inhibit heparin-binding epidermal growth factor (HB-EGF), or even its possible weak toxicity. CRM197 is utilized as a specific inhibitor of HB-EGF that competes for the epidermal growth factor receptor (EGFR), overexpressed in colorectal cancer and implicated in its progression. In this study we evaluate the effects of CRM197 on HT-29 human colon cancer cell line behaviour and, for CRM197 recognized ability to inhibit HB-EGF, its possible influence on EGFR activation. In particular, while HT-29 does not show any reduction of viability after CRM197 treatment (MTT modified assay), or changes in cell cycle distribution (flow cytometry), in EGFR localization, phospho-EGFR detected signals (immunohistochemistry) or in morphology (scanning electron microscopy, SEM) they show a change in the gene expression profile by microarray analysis (cDNA microarray SS-H19k8). The overexpression of genes like protein phosphatase 2, catalytic subunit, alpha isozyme (PPP2CA), guanine nucleotide-binding protein G subunit alpha-1(GNAI1) and butyrophilin, subfamily 2, member A1 (BTN2A1) has been confirmed with real-time-qPCR. This is the first study where the CRM197 treatment on HT-29 shows a possible scarce implication of endogenous HB-EGF on EGFR expression and cancer cell development. At the same time, our results show the alteration of a specific and selected number of genes.

Polylactide-Polyglycolide Resorbable Plates Stimulates Adipose Tissue-Derived Stem Cells towards Osteoblasts Differentiation

Polylactide, polyglycolide materials or devices have been utilized routinely during maxillofacial, craniofacial, and orthopaedic reconstructive surgical procedures.(1) These materials combine the benefits of rigid fixation with the advantages of biodegradation, avoiding the need for implant removal and minimizing the risk of other complications.(2) To study how polylactide, polyglycolide acids plates (PLPG plates) can induce osteoblast differentiation and proliferation in mesenchymal stem cells, the expression levels of bone related genes (RUNX2, SP7, ALPL, SPP1, COL1A1, COL3A1 and FOSL1) and mesenchymal stem cells marker (ENG) were measured in adipose derived stem cells (ADSCs) and normal osteoblast (NO) cultivated on PLPG plates after 15 and 30 days of treatment using real time Reverse Transcription-Polymerase Chain Reaction. Significantly differentially expressed genes among ADSCs and NO were SP7, ENG, FOSL1, RUNX, ALPL and SPP1 in the first 15 days of treatment and SP7, ENG FOSL1, COL3A1 COL1A1, SPP1 and ALPL after 30 days. The present study demonstrated that PLPG plates strongly influences the behavior of ADSCs in vitro by enhancing proliferation, differentiation and deposition of matrix.

Loh at PDCD4, CTNNB1, and CASP4 LOCI Contributes to Stage Progression of Oral Cancer

Squamous cell carcinoma is the most frequent malignant tumor of the oral cavity. Markers of tumor progression that could help to define diagnosis, plan treatment and implement prognosis have still to be identified. Seven candidate markers for tumor progression were investigated using a loss of heterozygosity (LOH) assay. The sample was made up of 51 squamous cell carcinoma and adjacent normal tissues from the same patients. LOH at one, or more, markers was a relatively frequent event that was observed in 53% of tumors. The number of losses detected in each tumor was significantly associated with tumor severity. Significant association between UICC stage grouping and LOH was found for 3 gene loci: programmed cell death 4 (PDCD4), catenin beta 1 (CTNNB1), and caspase 4 (CASP4). No association between allelic loss and the occurrence of lymph node metastasis was found for any of the seven investigated loci. Overall, LOH contributes to tumor progression of oral SCC. A specific role for PDCD4, CTNNB1, and CASP4 was found.

Evidence of LEF1 Fetal-Maternal Interaction in Cleft Lip with or without Cleft Palate in a Consistent Italian Sample Study

Epithelial mesenchymal transformation is considered a cardinal process in orofacial development. Several molecular players appear to be involved in this delicate mechanism; the activation of LEF1 transcription factor by transforming growth factor beta 3 seems to be a key step for the correct flow of events. The failure of orofacial processes during embryonic development may provoke cleft lip and/or cleft palate malformations. The scope of the present investigation was to verify whether genetic variants at LEF1 could influence the risk of orofacial clefting. The approach was a family based association study involving a total of 512 Italian patients and their parents, 401 having cleft lip with or without cleft palate (CL/P) and 111 with cleft palate only (CPO). Haplotype association analysis provided moderate evidence of an association with clefting (p 0.01). A log-linear likelihood-based method was used to verify maternal and foetal-maternal association. An association between the maternal genotype and the occurrence of CL/P was observed at two polymorphic loci, at rs10022956 (P = 0.0049) and rs10025431 (P = 0.0065) respectively, while a foetal-maternal effect modulating the risk of clefting was found at locus rs10025431 (P = 0.0071). These data further corroborate the importance of the mother's genotype with regard to susceptibility to malformations and early-onset diseases.

Study of the 12q13 Region in Nonsyndromic Cleft Lip with or without Cleft Palate

The 12q13 region has been suggested as a candidate locus for orofacial cleft by different investigators. In the present study we tested the region for linkage with non syndromic cleft lip with or without cleft palate in a collection of 39 Italian multigenerational families, using microsatellite markers. No evidence of linkage was detected between the marker map and NSCLP under different mode of inheritance nor with a nonparametric method. Formal level of linkage exclusion, were obtained for each point of the map. Genetic heterogeneity and the different impact of the candidate locus among populations could explain conflicting results obtained in different studies.

[Apparent life threatening event (ALTE): the role of the training in the follow-up]

AIM

The aim of this study was to give a support to the parents of the patients with apparent life threatening event (ALTE), to learn a correct management outside the protective environment of the hospital and a prevention such events.

METHODS

This was the 33rd edition of a training course called "Course of first aid and prevention of the accidents in infants", in which the recommendations of the Italian cardiopulmonary resuscitation's guidelines are treated. The course comprehended a short frontal lesson, a practice training and the compilation of a test to express one's satisfaction about the received training, using a points assessment from 1 to 10.

RESULTS

The course included 385 participants (including any kind of person who may be in contact with infants) and 361 questionnaires were returned. Critical parameters were the scheme of teaching, the adequacy of contents, the teachers' technical and behavioral abilities, the adequacy of time and the communicative capacity. The learners demonstrated pleasure in variable percentages from 98% to 100%. The 79% of the learners felt the necessity to have some training again later on.

CONCLUSION

Our positive experience allowed us to reflect about three concepts that we considered essential: communication, training and prevention. In fact, we think that prevention is infinitely potentiated from training and communication is its inalienable instrument.

Evidence of an Involvement of TFAP2A Gene in Nonsyndromic Cleft LIP with or without Cleft Palate: An Italian Study

Unraveling of factors involved in multifactorial diseases is a great challenge. Different approaches can be contemplate and applied to a variety of congenital malformations. In the present investigation TFAP2A has been considered a good candidate gene for nonsyndromic cleft lip with or without cleft palate (NSCLP) aetiology, basing on a sum of considerations. TFAP2A has been seen involved in orofacial development in mice; it is located in the NSCLP candidate region 6p24; it codes for a transcription factor which regulates expression of IRF6, a gene implied in NSCLP; finally, it is embroiled in the branchiooculofacial syndrome, that includes clefting as feature. A family based association analysis was performed with a sample study of 405 NSCLP triads. Evidence of association was obtained with both single marker and haplotype analyses, thus providing a support for TFAP2A in NSCLP aetiology.

No Association between Polymorphisms in Cubilin, a Gene of the Homocysteine Metabolism and the Risk of Non-Syndromic Cleft Lip with or without Cleft Palate

Epidemiological studies have correlated lower maternal periconceptional levels of plasma folate and cobalamin with increased risk of delivering offspring presenting congenital malformations such as cleft lip with or without cleft palate (CL/P) or neural tube defects. A number of genetic studies aimed at correlating these biochemical levels or the occurrence of malformations with specific genetic defects or polymorphisms have been successfully performed. The cubilin gene (CUBN) codes for a carrier that plays a crucial role in cobalamin cell internalization. CUBN polymorphisms were previously found to be associated with spina bifida occurrence. In this work, a family-based association study was performed to test CUBN involvement in CL/P. A sample of 391 CL/P triads was investigated with three single nucleotide polymorphisms mapping on the cubilin gene. Association tests indicated no significant association between CL/P and marker alleles or marker haplotypes. No evidence of maternal effect and imprinting were obtained. These data suggest that CUBN is not involved in CL/P onset in the investigated Italian population.

A single blind controlled comparison of tramadol/paracetamol combination and paracetamol in hand and foot surgery. A prospective study

The objective of this study was to compare the efficacy and effectiveness between an analgesic combination of tramadol/paracetamol (37.5+325 mg), and paracetamol monotherapy (1000 mg) for acute postoperative pain after hand and foot surgery. The study design was a single blind randomized controlled trial. A total of 114 patients who underwent hand and foot surgery under brachial plexus block were randomized to receive either paracetamol monotherapy (group P, n=57) or tramadol/paracetamol (group TP, n=57) postoperatively. The number of patients who required an extra-dose of analgesic pain score, and adverse affects were compared between the two groups. Analgesic requirement was significantly lower in those in the TP group when compared with the P group. In the TP group, the pain score after surgery was significantly lower than in the P group. Adverse effects did not significantly differ between the two groups. There were no serious adverse events in either group. The association of tramadol and paracetamol appears to have more efficacy when compared with paracetamol monotherapy for acute postoperative pain after hand and foot surgery.

Molecular surveillance of pandemic influenza A(H1N1) viruses circulating in Italy from May 2009 to February 2010: association between haemagglutinin mutations and clinical outcome

Haemagglutinin sequences of pandemic influenza A(H1N1) viruses circulating in Italy were examined, focusing on amino acid changes at position 222 because of its suggested pathogenic relevance. Among 169 patients, the D222G substitution was detected in three of 52 (5.8%) severe cases and in one of 117 (0.9%) mild cases, whereas the D222E mutation was more frequent and evenly distributed in mild (31.6%) and severe cases (38.4%). A cluster of D222E viruses among school children confirms reported human-to-human transmission of viruses mutated at amino acid position 222.

MicroRNA Expression Profiling of Oral Carcinoma Identifies New Markers of Tumor Progression

Oral squamous cell carcinoma, the most frequently occurring malignant head and neck tumour, generally exhibits poor prognosis and metastases are the main cause of death. The discovery of reliable prognostic indicators of tumour progression could greatly improve clinical practice. MicroRNAs are involved in the regulation of basic cellular processes such as cell proliferation, differentiation, and apoptosis. Since miRNAs have been shown to be abnormally expressed in different tumours their importance as potential cancer prognostic indicators is increasing. To define the role of miRNA in OSCC tumours we investigated the expression profile of 15 OSCC (8 without metastasis and 7 with lymph node metastasis) using microarray analysis. Thirteen miRNA were significantly overexpressed (miR-489, miR-129, miR-23a, miR-214, miR-23b, miR-92, miR-25, miR-210, miR-212, miR-515, miR-146b, miR-21, miR-338) and 6 miRNA were underexpressed (miR-520h, miR-197, miR-378, miR-135b, miR-224, miR-34a) in oral tumours. Underexpression of mir-155, let-7i, mir-146a was found to characterize progression to metastastatic tumours. Further investigations will elucidate whether differentially expressed miRNAs will help to better classify OSCCs, thus improving diagnoses and patient care.

Right hemisphere dysfunction and emotional processing in ALS: an fMRI study

Emotional processing may be abnormal in amyotrophic lateral sclerosis (ALS). Our aim was to explore functional anatomical correlates in the processing of aversive information in ALS patients. We examined the performance of nine non-demented ALS patients and 10 healthy controls on two functional MRI (fMRI) tasks, consisting of an emotional attribution task and a memory recognition task of unpleasant versus neutral stimuli. During the emotional decision task, subjects were asked to select one of three unpleasant or neutral words. During the memory task, subjects were asked to recognize words presented during the previous task. Controls showed, as expected, greater activation in the right middle frontal gyrus during selection of unpleasant than neutral words, and a greater activation mainly in right-sided cerebral areas during the emotional recognition task. Conversely, patients showed a general increase in activation of the left hemisphere, and reduced activation in right hemisphere in both emotional tasks. Such findings may suggest extra-motor neurodegeneration involving key circuits of emotions, mostly negative, commonly involved in FTD.

Quality of life and motor impairment in ALS: Italian validation of ALSAQ

OBJECTIVES

To evaluate the validity and reliability of the amyotrophic lateral sclerosis assessment questionnaire (ALSAQ) in an Italian cohort of ALS patients and to further characterize the relationship between motor impairment and quality of life (QoL) in ALS.

METHODS

Seventy-six patients completed the Italian version of ALSAQ-40 and ALSAQ-5. To verify test-retest reliability, 30 patients were revaluated after 3 months. The medical outcome study short form 36 (MOS SF-36) questionnaire and revised ALS functional rating scale (ALSFR-R) scale were used to assess Italian ALSAQ-40 construct validity. The limb muscles' Medical Research Council (MRC) score and forced vital capacity (FVC) were used to measure the degree of motor impairment.

RESULTS

The Italian ALSAQ-40 showed a very good internal consistency (all subscales Cronbach's alpha>0.86) and a good construct validity as shown by the patterns of correlation between the subscales and SF-36 (resp. ALSFRS-R) scores. ALSAQ-5 showed a positive correlation with the corresponding ALS patient total score and subscale scores of the ALSAQ-40 (Spearman's correlation coefficient>0.73). The emotional functioning subscale did not correlate with any motor impairment measures.

DISCUSSION

Italian ALSAQ-40 and ALSAQ-5 psychometric properties are reliable and similar to those showed by the original English version. We observed emotional aspects to be distinct from physical involvement.

Brain involvement in myotonic dystrophies: neuroimaging and neuropsychological comparative study in DM1 and DM2

The objective of this study was to determine the degree of brain involvement in a cohort of myotonic dystrophy type 1 and type 2 (DM1, DM2) patients by brain studies and functional tests and to compare the results of the two groups. DM1, DM2 are multisystemic disorders due to polynucleotide expansions. Previous studies on brain involvement by neuroimaging and functional methods have led to contradictory results. Fifty molecularly defined DM1 patients and 14 DM2 patients, were recruited for the study. Age at recruitment, age at disease onset, disease duration and educational level were recorded. Neuromuscular assessment was done by MIRS. An extensive neuropsychological battery was performed in 48/50 DM1 and in a control group of 44 healthy matched subjects. Forty six of 50 DM1 and 12/14 DM2 underwent brain MRI; 21/50 DM1 and 9/14 DM2 underwent brain perfusion SPECT, with semiquantitative analysis of the results. MRI images were classified by ARWMC (age-related white matter changes) score, in order to quantify recurrence, localization and patterns of distribution of white matter hyperintense lesions (WMHLs) in our two cohorts. MRI results were matched to SPECT and to neuropsychological results. Thirty-seven of 46 DM1 and 10/12 DM2 had abnormal MRI imaging, showing scattered supratentorial, bilateral, symmetrical focal or diffuse WMHLs. A typical temporo-insular diffuse subcortical pattern was seen in DM1 subjects only, with no correlation with cognitive involvement. Major cognitive involvement was seen in the case of diffuse frontal lesions. A relationship with CTG expansion size was documented for DM1 subjects. SPECT showed minimal hypoperfusion in the posterior cortex planes in DM1 and, to a lesser extent, in DM2. Very mild degrees of involvement in the DM2 cohort were seen. Neuroimaging and functional investigations confirmed a more severe involvement of the brain in DM1 compared to DM2. A temporo-insular diffuse lesional pattern, specific for DM1, was found on MRI. This confirms greater expansion size as a risk factor for more extensive brain involvement in DM1.