The use of hyaluronic acid in the treatment of shoulder capsulitis: a systematic review

Adhesive capsulitis (AC) is a common pathological condition of the shoulder characterized by painful restriction of range of motion (ROM) of the glenohumeral joint. Currently, no consensus has been reached regarding the best treatment. Hyaluronic acid (HA) injection is a safe procedure that can result in significant improvement in active and passive ROM, alleviating pain and improving shoulder function. We systematically reviewed current literature in order to evaluate the best evidence about the effectiveness of intra-articular HA injection for the treatment of primary AC. We searched Medline, CINAHL, Embase, Google Scholar and Cochrane Library. We selected studies comparing clinical outcomes of patients treated with HA in association or not with conventional therapy. Seven studies were evaluated: 2 uncontrolled randomized studies and 5 prospective randomized clinical trials with level of evidence I. Clinical outcome measures used included, among other, ROM, Visual Analogic Scale (VAS) pain scores, Constant score, Activity of daily living, Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopedic Association Score (JOA score). Improvement was noted in terms of ROM, constant scores and pain in patients affected by AC treated with intra-articular HA injections. When compared with cortisone intra-articular injection, HA has equivalent clinical outcomes and ROM. The heterogeneity of treatments used in the studies reviewed, makes it difficult to draw a definite conclusion on the subject. HA injections do not seem to determine the final outcomes directly compared with conventional treatments. However, they could play an important role for early mobilization in the initial stages, during which, due to pain and inflammation, the patient keeps the shoulder immobilized for a long time, determining the direct cause of AC. Numerous variables, including use of lidocaine, different HA and AC stages, could influence the results and deserve to be accounted for in future investigations.

The use of hyaluronic acid in the treatment of ankle osteoarthritis: a review of the evidence

Ankle osteoarthritis (OA) is a progressive degenerative joint disease that causes ankle pain and functional limitation especially during walking. It tends to involve younger people with high functional request and has often a post-traumatic origin. Symptoms control through conservative treatment is essential to procrastinate as long as possible the need for surgery. Although few data are present in literature about the use of local viscosupplementation in ankle OA, their potential use for ankle OA has been suggested. We systematically reviewed literature to evaluate the best evidence about short and long term effectiveness of intra-articular HA injections in the treatment of ankle OA. After having screened titles and abstracts from PubMed, Ovid, Cochrane Reviews, Google Scholar, we identified 14 full text articles and collected the outcome rates of intra-articular cycles of HA injections in patients with symptomatic ankle OA. Only 4 randomized control trials were included. Ankle Osteoarthritis Scales (AOS), American Orthopedic Foot, Ankle Society (AOFAS) clinical rating score, visual analog scales (VAS), Western Ontario and McMaster Universities (WOMAC) OA Index of Pain, Stiffness, and Physical Function Score were most frequently used to evaluate outcomes. Although randomized trials showed scores improvement also in placebo-treated patients, current evidence suggests that viscosupplementation for treatment of ankle OA is a safe and effective method. More randomized controlled trials with a large number of patients that compare not only the different types, dosages and frequency of HA injections, but also the effectiveness of HA versus corticosteroids infiltrations and HA versus other types of conservative treatment are still needed.

Meniscal extrusion as booster of osteoarthritis

Meniscal extrusion (ME) has shown to play a critical but still unclear role in osteoarthritis (OA) development. ME has been described as an important risk factor in the progression of knee OA, as it is involved in the thinning of articular cartilage, joint space narrowing, spontaneous osteonecrosis of the knee and subchondral bone marrow lesions. Meniscal damage of any degree of severity could cause ME in both compartments, but it is commonly associated with severe meniscal tears or root tears mainly in the medial meniscus. Magnetic resonance imaging is the most commonly used imaging modality in the assessment of ME, while ultrasonography may represent a valid alternative with high sensitivity and specificity. Conservative treatment for ME includes physical therapy and rehabilitation to maintain range of motion, corticosteroid injections and intra-articular injections of hyaluronic acid to provide short-term relief of knee pain. The goal of this study is to review standards of current diagnosis and treatment of ME and its relationship to knee OA.

A new surgical positioning system for robotic assisted minimally invasive spine surgery and transpedicular approach to the disc

Minimally Invasive Spine Surgery (MISS) procedures for the treatment of spinal pathologies have experienced exponential growth due to improved techniques and decreased trauma to the patient. Several MISS procedures that require the use of a trans-pedicular cannula as a guiding tool for pedicle screw placement, delivery of biomaterials to the vertebral body or injection of biologics to the disc space have been described. Although these are clear advantages of MISS, the limited dissection and exposure may reduce the accuracy and stability of operation and make spine surgeons rely heavily on intraoperative fluoroscopy, raising concerns over the level of radiation exposure. Robot-assisted minimal invasive surgery has aroused more attention for its high precision and stability, minimizing risks of damage to neurovascular structures and diminishing harmful exposure to ionizing radiation. The aim of this paper is to describe and characterize a new surgical positioning system for for robotic assisted MISS. The system is conceived to be integrated in a surgical platform capable of supporting the surgeon in a new procedure to treat degenerative intervertebral disc disease. For this purpose, it is necessary to orientate a cannula in order to guide the bone drill along a planned route, to access the intervertebral disc through the pedicle and endplate. In particular, we describe a mechanism that percutaneously guides a cannula towards the intervertebral disc based on the acquisition of few fluoroscopic images. The design of the positioning system, with its features and constrains imposed by the presence of instrumentation and medical staff in the operating room, as well as the software for trajectory planning during surgery, are here described.

Reconstruction Techniques of Choice for the Facial Cosmetic Units

BACKGROUND AND OBJECTIVES

A broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units.

MATERIAL AND METHODS

This was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second.

RESULTS

The total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip.

CONCLUSIONS

The results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.

Expression and distribution of leptin and its receptors in the digestive tract of DIO (diet-induced obese) zebrafish

The expression and localization of leptin (A and B) and its receptor family in control and diet-induced obese (DIO) adult male zebrafish gut, after 5-weeks overfeeding, administering Artemia nauplii, as fat-rich food, were investigated. Recently, the obese adult zebrafish was considered an experimental model with pathophysiological pathways similar to mammalian obesity. Currently, there are no reports about leptin in fish obesity, or in a state of altered energy balance. By qRT-PCR, leptin A and leptin B expression levels were significantly higher in DIO zebrafish gut than in the control group (CTRL), and the lowest levels of leptin receptor mRNA appeared in DIO zebrafish gut. The presence of leptin and its receptor proteins in the intestinal tract was detected by western blot analysis in both control and DIO zebrafish. By single immunohistochemical staining, leptin and leptin receptor immunoreactive endocrine cells were identified in the intestinal tract either in DIO or control zebrafish. Moreover, leptin immunopositive enteric nervous system elements were observed in both groups. By double immunohistochemical staining, leptin and its receptor were colocalized especially in DIO zebrafish. Thus, our study represents a starting point in the investigation of a possible involvement of leptin in control of energy homeostasis in control and DIO zebrafish.

Exploring the Correlation Between Perceived Attachment Security and Levels of GH Hormone in a Sample of Children with Non-organic Failure to Thrive: Preliminary Findings

Introduction

Short stature caused by growth hormone (GH) deficiency is one of the causes of the “Failure to Thrive” (FTT) condition. In absence of clear organic causes, several different psychosocial conditions may play a role in explaining the FTT phenotype. Advances in developmental psychology have highlighted the role of emotions and caregiving behaviors in the organization of child's personality and psychobiology, with the mother–son attachment bond being considered a fundamental developmental experience. The objective of the present preliminary study was to assess whether there are significant correlations between attachment styles and GH levels in a sample of subjects with non-organic FTT.

Methods

We enrolled 27 children (mean age: 9.49 ± 2.63) with non-organic FTT. Perceived attachment security was assessed through the Security Scale (SS) and its subscales focused on maternal and paternal security. Pearson partial correlation was used to test associations between GH levels and SS measures adjusting for confounding factors (i.e. age, gender and BMI).

Results

Across all subjects, GH was significantly positively correlated with general security (r = 0.425; P = 0.038) and maternal security (SSM) (r = –0.451; P = 0.027) and not significantly correlated with paternal security (SSP) (r = 0.237; P = 0.264).

Discussion

These findings preliminarily suggest that perceived attachment security may play a role in the etiopathogenesis of non-organic GH deficiencies and add to the accumulating evidence that attachment styles are associated with specific psychoendocrine underpinnings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Comparing hybrid hyaluronic acid with PRP in end career athletes with degenerative cartilage lesions of the knee

Cartilage lesions are very common causes of chronic knee pain in athletes. Current treatment options consist in conservative strategies, such as viscosupplementation and platelet-rich plasma injections. This randomized controlled trial aims to investigate the effect of intra-articular Hybrid Hyaluronic Acid injections compared to PRP for the treatment of cartilage lesions among athletes at the end of their career. Since March 2015, 48 professional soccer players were randomized into two groups: 24 patients received 3 injections of HHA and 23 patients received 3 intra-articular injections of PRP. All patients achieved a statistically significant clinical improvement from preoperative to postoperative time in both groups. Patients in the HHA group showed a significant superiority compared to PRP group at 3 and 6 months. Intergroup differences decrease gradually until loss of significance at 12 months follow-up. Athletes with chronic degenerative cartilage lesions of the knee responded positively both to HHA and PRP until last follow up.

Mesenchymal stem cells for intervertebral disc regeneration

Low back pain (LBP) is one of the most common disabling symptoms affecting the adult population throughout the industrialized world. The main cause underlying this condition is intervertebral disc degeneration (IDD), which is characterized by progressive decrease of the proteoglycan content within the nucleus pulposus (NP), leading to disc dehydration and loss of its morpho-functional and biomechanical properties. To date, LBP treatment is based upon conservative and invasive procedures which are not capable of restoring the degenerative alterations of the disc, as they only help relieve the symptoms and/or slow down disc degeneration and are, nonetheless, characterized by significant comorbidities, costs and secondary risks. The potential use of different mesenchymal stem/stromal cells (MSCs) for treating IDD has been promisingly tested in vitro and in vivo. The combination of different cell types, preconditioning culture conditions, engineered scaffolds and delivery systems have yielded proof of disc matrix reconstitution, increased cell viability and tissue regeneration in several experimental settings. This article reviews the current literature on stem cell-based therapy for IDD and the outcomes that diverse approaches have achieved.

Bone marrow concentrated cells and stromal vascular fraction cells injections for osteoarthritis treatment: a systematic review

The aim of this systematic review is to examine current clinical evidences supporting the intraarticular injection of bone marrow concentrate cells (BMC) and adipose-derived stromal vascular fraction cells (SVF) for the treatment of osteoarthritis (OA). The research was performed on PubMed (Medline), EMBASE and Cochrane Library considering the English literature. Only clinical trials have been included. The systematic research identified twelve clinical trials. Articles included in the study, were one of level II, four of level III, six of level IV and one level V. Among clinical trials, none were randomized, four were comparative, seven were case series, and one was a case report. Seven studies were focused on the use of SVF (1332 patients) and five on the use of BMC (963 patients), with preliminary interesting findings in the OA treatment. Despite the growing interest in this biological approach for OA, knowledge on this topic is still preliminary. Randomized controlled trials are needed to support the potential of BMC and SVF injections and to evaluate advantages and disadvantages with respect to the available treatments.

Autologous bone marrow concentrate combined with platelet-rich plasma enhance bone allograft potential to induce spinal fusion

Bone marrow cells concentrate (BMCs) is a source of osteoprogenitor cells and platelet-rich plasma (PRP) is a source of growth factors. The objective of the study was to determine whether BMC and PRP could increase the potential of bone allograft to induce posterolateral-lumbar spinal fusion compared to the bone allograft alone. A prospective nonrandomized radiographic study has been conduced on 10 patients with posterolateral instrumented fusion for degenerative lumbar disease with 1-year follow-up using CT scan. A fresh frozen bone allograft alone and bone allograft with a mixture of autologous BMC and PRP blended with thrombin were apposed in the right and left posterolateral side, respectively. CT showed good right fusion masses (allograft alone) in 4 patients and poor in 6; good left masses (BMC and PRP plus allograft) in 9 patients and poor in 1. The differences detected between right-side and left-side masses show an advantage in adding BMC and PRP to the bone allograft to increase spinal fusion rate.

The role of Helicobacter pylori LPS in the pathogenesis of H. pylori-related gastropathy

Helicobacter pylori strains and/or their lipopolysaccharides (LPS) represent the trigger of different regional and systemic immune responses in the course of H. pylori-related gastropathy as indicated by the following: (i) in patients with chronic gastritis (CG) or duodenal ulcer (DU), eradication of H. pylori leads to a dramatic decrease of gastric mucosal content of various cytokines such as interleukin-1β and transforming growth factor-β1; (ii) gastric epithelial cells are activated by H. pylori organisms through tyrosine phosphorylation signaling events but H. pylori LPSs do not affect this signal transduction pathway; and (iii) in sera from patients with CG and DU, besides antibodies to S-form LPS, humoral IgG and IgA response against R-form LPS has been also detected. On the other hand, antibodies against synthetic polymeric Lewisx were found in a few patients with CG and in no patients with DU.

Pattern of γ-glutamyl transferase activity in cow milk throughout lactation and relationships with metabolic conditions and milk composition

The main objective of this experiment was to study the γ-glutamyl transferase (GGT) activity in milk during lactation and its relationship with metabolic status of dairy cows, milk yield, milk composition, and cheesemaking properties. The study was performed in a tied stall barn and involved 20 lactations from 12 healthy multiparous Italian Friesian dairy cows. During lactation starting at d 10, milk samples were collected weekly and analyzed for composition, somatic cells count, titratable acidity, and milk coagulation properties. The GGT activity was measured in defatted samples. Blood samples were collected weekly to assess biochemical indicators related to energy, protein, and mineral metabolism, markers of inflammation and some enzyme activities. The lactations of each cow were retrospectively categorized into 2 groups according to their milk GGT activity value through lactation. A median value of GGT activity in the milk of all lactations was calculated (3,045 U/L), and 10 lactations with lower GGT activity were classified as low while 10 lactations with greater GGT activity were classified as high. The average value of milk GGT activity during lactation was 3,863 and 3,024 U/L for high and low, respectively. The GGT activity decreased in early lactation and reached minimum values in the second month (3,289 and 2,355 U/L for high and low, respectively). Thereafter GGT activity increased progressively, reaching values in late lactation of 4,511 and 3,540 U/L in high and low, respectively. On average, milk yield was 40.81 and 42.76 kg/d in high and low, respectively, and a negative partial correlation with milk GGT activity was observed. A greater milk protein concentration was observed in high (3.39%) compared with low (3.18%), and a positive partial correlation with milk GGT activity was observed. Greater titratable acidity in high than that in low (3.75 vs. 3.45 degrees Soxhlet-Henkel/50 mL, respectively) was also observed. Plasma glucose was greater in cows of high than in low group, while plasma urea was lower in the high than in the low group. No relationship between plasma GGT and milk GGT activity was observed. Our results show an important effect of lactation stage on milk GGT activity. The individual effect observed from consecutive lactations and the relationship between milk GGT activity and milk protein concentration in healthy cows could open prospects for GGT as a future tool in improving milk protein content.

A surveillance system of Invasive Pneumococcal Disease in North-Eastern Italy

BACKGROUND

From 2007, in the Veneto Region (Italy), a surveillance system for invasive pneumococcal diseases (IPD) was implemented to estimate the regional epidemiology of IPD and to evaluate the impact of 13-valent pneumococcal conjugate vaccine (PCV13) vaccination.

METHODS

Data were collected from 2007 to 2014 and the total, annual and age-specific IPD notification rates were calculated. A Poisson regression model was used to identify the possible risk factors for developing IPD.

RESULTS

A total of 713 IPD cases were notified and the overall IPD notification rate was equal to 2.0 cases per 100,000 population (95% CI: 1.7-2.1), with an increasing trend between 2007 and 2014. The pneumococcal serotypes were identified in 608 (85.3%) isolates from biological specimens, and the most distributed serotypes were those contained in PCV13. Children <5 year-old and the adults over 65 year-old showed the highest PCV13 vaccine-type IPD notification rate, equal to 2.7/100,000 and 2.8/100,000, respectively. The risk to develop IPD was greater in children aged <5 years (RR = 8.9, 95% CI: 5.1-15.9; p<0.0001) and in adults aged >65 years (RR = 4.3, 95% CI: 2.7-6.9; p<0.0001), especially in males > 65 years of age (RR = 1.7, 95% CI: 1.0-2.8; p = 0.042). The invasive pneumococcal disease was mainly caused by the PCV13 serotypes (RR = 2.9, 95%CI: 2.3-3.9; p<0.0001), principally after the PCV13 introduction (RR = 2.3, 95% CI: 1.4-3.8; p<0.001). In spite of that, a significant reduction of the overall IPD incidence is evident in the period following the PCV13 vaccine introduction (RR = 0.4, 95% CI: 0.3-0.5; p<0.0001), particularly in children aged <5 years (RR = 0.3, 95% CI: 0.2-0.7; p = 0.002), demonstrating the real efficacy of PCV13 immunization for children.

CONCLUSIONS

In the Veneto Region, the surveillance system has allowed to describe the detailed epidemiological profile of invasive pneumococcal disease, pointing out that the most circulating pneumococcal serotypes were those contained in the PCV13 vaccine.

BIOTECHNOLOGIES AND BIOMATERIALS IN SPINE SURGERY

Over the past few decades, spine disorders have become a major health concern and the number of spinal surgical procedures has been rising significantly. Several biotechnologies and biomaterials are often used in spine surgery to increase the effectiveness of the treatment. In the degenerative spine, when conservative treatment is ineffective the most recommended surgical procedure is decompression followed by spinal fusion. Success rates of spine fusion extensively rely on bone grafts peculiar properties. Autograft has been considered the gold standard to achieve a solid fusion but current research is focused on the development of new biomaterials. Osteoporosis is the main cause of vertebral compression fractures that are significantly associated with pain and disability, especially in the aging population. Vertebral augmentation is a minimally invasive approach in which cement is injected into the vertebral body to stabilize the fracture. New cements are being developed in the clinical scenario with reabsorbable properties and biomechanical features more similar to the native bone. The development of disc regeneration strategies such as nucleus pulposus restoration and annulus fibrosus repair may represent a minimally invasive procedure towards regeneration rather than fusion. Therefore, biomaterials and tissue engineering are fields of growing interest among both surgeons and manufacturing companies, with a major involvement in spine surgery. This review discusses current and novel biotechnologies and biomaterial used in spine surgery employing fusion, augmentation and regeneration.

Bioadhesive hydrogels for cosmetic applications

INTRODUCTION

The use of bioadhesive hydrogels for skin care presents important advantages such as long residence times on the application site and reduced product administration frequency.

OBJECT

The aim of the present work was to develop bioadhesive hydrogels for skin application, using caffeine as a model active ingredient.

METHODS

Eight hydrogels were formulated using binary combinations of a primary polymer (carbomer homopolymer type C (Carbopol(®) 980) or kappa carrageenan potassium salt (Gelcarin(®) GP-812 NF)) and a secondary polymer (carbomer copolymer type B (Pemulen(™) TR-1), xanthan gum or guar gum). Hydrogels were characterized by means of physico-chemical (dynamic rheological measurements, spreadability and adhesion measurements) and sensory methods (projective mapping in combination with a check-all-that-apply (CATA) question). Caffeine hydrogels were formulated using two of the most promising formulations regarding adhesion properties and sensory characteristics. In vitro active ingredient release studies were carried out.

RESULTS

Hydrogel formulations showed a prevalently elastic rheological behaviour. Complex viscosity of carbomer homopolymer type C hydrogels was higher than that of the kappa carrageenan hydrogels. Besides, complex viscosity values were dependent on the secondary polymer present in the formulation. Significant differences among hydrogels were found in detachment force, work of adhesion and spreading diameter results. Association of projective mapping with CATA allowed to determine similarities and dissimilarities among samples. Cluster analysis associated the samples in two groups. Two hydrogels were selected to study the release of caffeine. Both hydrogels presented similar release profiles which were well described by the Higuchi model. Caffeine release was exclusively controlled by a diffusive process.

CONCLUSION

Physico-chemical and sensory techniques enabled the identification of bioadhesive hydrogel formulations with positive characteristics for cosmetic applications. Formulations which combined carbomer homopolymer type C with xanthan gum or with carbomer copolymer type B were the most promising for bioadhesive skin products. Caffeine release profiles of selected formulations were not statistically different. Both hydrogels gradually released the active ingredient, reaching approximately 80% within the first 5 h, and their profiles were well described by the Higuchi model. In this context, it could be concluded that the selected hydrogels are suitable bioadhesive hydrogel formulations for cosmetic application on the skin.

Texture features on T2-weighted magnetic resonance imaging: new potential biomarkers for prostate cancer aggressiveness

To explore contrast (C) and homogeneity (H) gray-level co-occurrence matrix texture features on T2-weighted (T2w) Magnetic Resonance (MR) images and apparent diffusion coefficient (ADC) maps for predicting prostate cancer (PCa) aggressiveness, and to compare them with traditional ADC metrics for differentiating low- from intermediate/high-grade PCas. The local Ethics Committee approved this prospective study of 93 patients (median age, 65 years), who underwent 1.5 T multiparametric endorectal MR imaging before prostatectomy. Clinically significant (volume ≥0.5 ml) peripheral tumours were outlined on histological sections, contoured on T2w and ADC images, and their pathological Gleason Score (pGS) was recorded. C, H, and traditional ADC metrics (mean, median, 10th and 25th percentile) were calculated on the largest lesion slice, and correlated with the pGS through the Spearman correlation coefficient. The area under the receiver operating characteristic curve (AUC) assessed how parameters differentiate pGS = 6 from pGS ≥ 7. The dataset included 49 clinically significant PCas with a balanced distribution of pGS. The Spearman ρ and AUC values on ADC were: -0.489, 0.823 (mean); -0.522, 0.821 (median); -0.569, 0.854 (10th percentile); -0.556, 0.854 (25th percentile); -0.386, 0.871 (C); 0.533, 0.923 (H); while on T2w they were: -0.654, 0.945 (C); 0.645, 0.962 (H). AUC of H on ADC and T2w, and C on T2w were significantly higher than that of the mean ADC (p = 0.05). H and C calculated on T2w images outperform ADC parameters in correlating with pGS and differentiating low- from intermediate/high-risk PCas, supporting the role of T2w MR imaging in assessing PCa biological aggressiveness.

Peripartum cardiomyopathy: Euro Observational Research Program

Peripartum cardiomyopathy is a rare but potentially life-threatening form of heart failure affecting women late in pregnancy or in the first months after delivery. Peripartum cardiomyopathy is difficult to diagnose and its onset and progression are variable between individuals. The pathophysiology remains poorly understood, hence treatment options are limited and possibly harmful to the foetus. Furthermore, geographical incidence varies greatly and little is known about the incidence in Western countries. To gain further understanding of the pathophysiology and incidence of peripartum cardiomyopathy, the European Society of Cardiology initiated a study group to implement a registry. This review provides an overview of current insights into peripartum cardiomyopathy, highlights the need for such a registry and provides information about this Euro Observational Research Program.

Distribution pattern of hepatitis C virus genotypes and correlation with viral load and risk factors in chronic positive patients

OBJECTIVE

Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. The purpose of this study was to describe the distribution pattern of HCV genotypes in chronic hepatitis patients in the Campania region of southern Italy and estimate their association with risk factors and viral load.

MATERIALS AND METHODS

404 consecutive HCV ribonucleic acid-positive patients were included in the study. HCV genotyping was carried out by the HCV line probe assay test and viral load estimation by the TaqMan real-time PCR system.

RESULTS

The predominant genotype was 1 (63.6%), followed by genotype 2 (29.4%), 3 (6.2%) and 4 (0.8%). Subtype 1b was more frequent in females than in males. Conversely, genotype 3 was more frequent in males. No significant difference was observed in age distribution of HCV genotypes. Surgery and dental therapy were the most frequent risk factors for genotype 1 and intravenous drug abuse and tattooing for genotype 3. Patients with genotype 1 more frequently showed high HCV viral load when compared to those with genotypes 2 and 3.

CONCLUSION

The present study revealed that HCV genotypes 1 and 2 accounted for over 95% of all HCV infections in the Campania region, and genotype 1 was more frequently associated with a higher viral load when compared to genotypes 2 and 3.

Commensal symbiosis between agglutinated polychaetes and sulfate-reducing bacteria

Pendant bioconstructions occur within submerged caves in the Plemmirio Marine Protected Area in SE Sicily, Italy. These rigid structures, here termed biostalactites, were synsedimentarily lithified by clotted-peloidal microbial carbonate that has a high bacterial lipid biomarker content with abundant compounds derived from sulfate-reducing bacteria. The main framework builders are polychaete serpulid worms, mainly Protula with subordinate Semivermilia and Josephella. These polychaetes have lamellar and/or fibrillar wall structure. In contrast, small agglutinated terebellid tubes, which are a minor component of the biostalactites, are discontinuous and irregular with a peloidal micritic microfabric. The peloids, formed by bacterial sulfate reduction, appear to have been utilized by terebellids to construct tubes in an environment where other particulate sediment is scarce. We suggest that the bacteria obtained food from the worms in the form of fecal material and/or from the decaying tissue of surrounding organisms and that the worms obtained peloidal micrite with which to construct their tubes, either as grains and/or as tube encompassing biofilm. Peloidal worm tubes have rarely been reported in the recent but closely resemble examples in the geological record that extend back at least to the early Carboniferous. This suggests a long-lived commensal relationship between some polychaete worms and heterotrophic, especially sulfate-reducing, bacteria.

[Hemodiafiltration with endogenous reinfusion in chronic inflammation: a possible therapeutic alternative?]

The patients under maintenance haemodialysis (HD) continue to have an unacceptably excess of mortality compared to general population, that may be explained by high prevalence of inflammation that significantly influences the survival of these patients. Indeed, chronic inflammation is very common in HD and it may cause malnutrition and progression of atherosclerotic disease by several pathogenetic mechanisms triggered by pro-inflammatory cytokines. Currently no pharmacological intervention is specifically targeted the idiopathic chronic inflammation. Hemodiafiltration with endogenous reinfusion (HFR) is a dialysis technique, highly biocompatible, that combines three depurative mechanisms: diffusion, convection and absorption. The ultrafiltrate is obtained from convective section of dialyzer (convection). It is regenerated by passing through the adsorbent macro-porous synthetic resin cartridge (absorption) and then it is reinfused into the second section of the filter (diffusion). This resin cartridge is able to absorb cytokines and other uremic toxins, whereas allows to pass nutrients and antioxidants, as amino acids and vitamins, with a consequent decrement of inflammation and oxidative stress. These characteristics suggest the use of HFR in HD patients affected by overt and idiopathic chronic inflammation. In these patients, we observed that the switching from Bic-HD to HFR allowed an improvement of inflammatory as testified by a significant decrement of serum levels of CRP IL-6, IL-1 and TNF- and a significant increase of albumin and pre-albumin. Whether these favorable effects may modify the outcomes of these high-risk patients, needs to be confirmed by studies ad-hoc.

Whole genome sequencing and phylogenetic analysis of West Nile virus lineage 1 and lineage 2 from human cases of infection, Italy, August 2013

A human outbreak of West Nile virus (WNV) infection caused by WNV lineage 2 is ongoing in northern Italy. Analysis of six WNV genome sequences obtained from clinical specimens demonstrated similarities with strains circulating in central Europe and Greece and the presence of unique amino acid changes that identify a new viral strain. In addition, WNV lineage 1 Livenza, responsible for a large outbreak in north-eastern Italy in 2012, was fully sequenced from a blood donor during this 2013 outbreak.

Antiproliferative and proapoptotic effects of viable or heat-killed Lactobacillus paracasei IMPC2.1 and Lactobacillus rhamnosus GG in HGC-27 gastric and DLD-1 colon cell lines

Data from literature suggest the possible use of probiotics as chemopreventive agents against colon cancer, but few investigations are available on their effects on gastric cancer proliferation. In our previous study, a specific Lactobacillus, strain L. paracasei IMPC2.1, was demonstrated to colonize the human gut and positively affect fecal bacteria and biochemical parameters. The aims of the present study were to investigate the effects of L. paracasei IMPC2.1, comparing them with those of Lactobacillus rhamnosus GG (L.GG), either as viable or heat-killed cells, on cell proliferation and apoptosis in a gastric cancer (HGC-27) and a colorectal cancer cell line (DLD-1). Both the gastric and colon cancer cells were sensitive to the growth inhibition and apoptosis induction by both viable or heat-killed cells from L. paracasei IMPC2.1 and L.GG. These findings suggest the possibility for a food supplement, based on dead probiotics, including L. paracasei IMPC2.1 cells, which could represent an effective component of a functional food strategy for cancer growth inhibition, with potential for cancer prevention.

Side-to-side cavocavostomy in adult piggyback liver transplantation

OBJECTIVE

Our objective was to perform a retrospective study that described the anastomosis technique as well as the complications of side-to-side cavo-caval reconstruction.

PATIENTS AND METHODS

From June 1998 to April 2011, we performed 284 liver transplantations including 10 adults with live donor organs. In all cases but 2 (272), cavo-caval reconstruction was performed using side-to-side cavo-caval (STSCC) anastomosis. In 19 cases (6.9%), we also carried out an end-to-side temporary porto-caval shunt (TPCS). In 17 cases (6.2%) the technique was performed for retransplantation.

RESULTS

STSCC anastomosis was technically feasible in all but 2 cases, regardless of the recipient's vena cava, anatomic factors, or graft size. Mean operative time for the STSCC was 13 minutes (range, 6-25). Routine Doppler ultrasonography was performed intraoperatively at the end of the surgery. There was no case of cava stump thrombosis. Complications associated with this technique were limited to 2 patients. One complication was torsion due to donor graft/recipient mismatch, which was successfully treated surgically by falciform ligament fixation. The second complication was only evident by sinusoidal congestion and was managed nonoperatively. Seventeen cases were uneventful for retransplant recipients.

CONCLUSIONS

STSCC during piggyback liver transplantation is safe and can be performed in the retransplantation setting, with a low incidence of venous outflow obstruction that can be associated with the traditional piggyback technique. Our data suggest that donor graft to recipient mismatch is not an absolute contraindication when proper body size match is considered. A wide anastomosis with typical recipient hepatic vein inclusion is warranted with routine postanastomotic Doppler ultrasonography.

Immunological detection of m- and µ-calpains in the skeletal muscle of Marchigiana cattle

Calpains are Ca²⁺-dependent proteases able to cleave a large number of proteins involved in many biological functions. Particularly, in skeletal muscle they are involved in meat tenderizing during post mortem storage. In this report we analyzed the presence and expression of µ- and m-calpains in two skeletal muscles of the Marchigiana cattle soon after slaughter, using immunocytochemical and immunohistochemical techniques, Western blotting analysis and Casein Zymography. Therefore, the presence and the activity of these proteases was investigated until 15^th day post mortem during normal process of meat tenderizing. The results showed m- and µ-calpain immunosignals in the cytoplasm both along the Z disk/I band regions and in the form of intracellular stores. Moreover, the expression level of µ-calpain but not m-calpain decreased after 10 days of storage. Such a decrease in µ-calpain was accompanied by a gradual reduction of activity. On the contrary, m-calpain activity persisted up to 15 days of post mortem storage. Such data indicate that expression and activity of both µ-calpain and m-calpain analyzed in the Marchigiana cattle persist longer than reported in literature for other bovines and may be related to both the type of muscle and breed examined.

Comparison between PUN and Tofts models in the quantification of dynamic contrast-enhanced MR imaging

Dynamic contrast-enhanced study in magnetic resonance imaging (DCE-MRI) is an important tool in oncology to visualize tissues vascularization and to define tumour aggressiveness on the basis of an altered perfusion and permeability. Pharmacokinetic models are generally used to extract hemodynamic parameters, providing a quantitative description of the contrast uptake and wash-out. Empirical functions can also be used to fit experimental data without the need of any assumption about tumour physiology, as in pharmacokinetic models, increasing their diagnostic utility, in particular when automatic diagnosis systems are implemented on the basis of an MRI multi-parametric approach. Phenomenological universalities (PUN) represent a novel tool for experimental research and offer a simple and systematic method to represent a set of data independent of the application field. DCE-MRI acquisitions can thus be advantageously evaluated by the extended PUN class, providing a convenient diagnostic tool to analyse functional studies, adding a new set of features for the classification of malignant and benign lesions in computer aided detection systems. In this work the Tofts pharmacokinetic model and the class EU1 generated by the PUN description were compared in the study of DCE-MRI of the prostate, evaluating complexity of model implementation, goodness of fitting results, classification performances and computational cost. The mean R² obtained with the EU1 and Tofts model were equal to 0.96 and 0.90, respectively, and the classification performances achieved by the EU1 model and the Tofts implementation discriminated malignant from benign tissues with an area under the receiver operating characteristic curve equal to 0.92 and 0.91, respectively. Furthermore, the EU1 model has a simpler functional form which reduces implementation complexity and computational time, requiring 6 min to complete a patient elaboration process, instead of 8 min needed for the Tofts model analysis.

Clinical and virological findings in the ongoing outbreak of West Nile virus Livenza strain in northern Italy, July to September 2012

In July-September 2012, one month earlier than in previous years, 13 confirmed human cases of West Nile virus infection were diagnosed in northern Italy, including five with neuroinvasive disease, three with West Nile fever, and five West Nile virus (WNV)-positive blood donors. In nine cases, the presence of the WNV lineage 1a Livenza strain, characterised in 2011, was ascertained. Symptomatic patients had prolonged viruria with high viral load.

Clinical and virological findings in the ongoing outbreak of West Nile virus Livenza strain in northern Italy, July to September 2012

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New endemic West Nile virus lineage 1a in northern Italy, July 2012

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Biphasic large cell neuroendocrine carcinoma--pure mucinous carcinoma of the gallbladder (MANEC): a unique combination

INTRODUCTION

We report a case of primary combined large cell neuroendocrine carcinoma (LCNEC)--pure mucinous carcinoma of the gallbladder (MANEC)--which represents the first description of this entity.

METHODS

The patient is a 59-year-old Italian male who underwent cholecystectomy under a preoperative diagnosis of cholecystitis with gallstones and gallbladder tumour. During laparotomy, cholecystectomy, liver wedge resection and regional lymph node dissection were performed. The resected gallbladder showed a thickened wall, gallstones and a 4 cm gelatinous, cauliflower-like soft tissue mass.

RESULTS

Following surgery, the gallbladder tumour was diagnosed as a mixed endocrine-exocrine carcinoma. There was evidence of lymph node metastasis or direct liver invasion. The mucin-producing carcinoma was composed of poorly differentiated glandular cells with mucin lakes. The LCNEC was characterized by large cells with prominent nucleoli, coarse chromatin and a high mitotic rate. The cells showed an "organoid" growth pattern with rosette formation and frequent areas of necrosis. Chromogranin A, synaptophysin and CD56 were diffusely and strongly expressed.

DISCUSSION

This case may provide helpful insights regarding the histogenesis of this unusual combination of tumors: the concept of a collision tumor between two neoplasms that have arisen in adjacent areas may be the best explanation for its pathogenesis.

Myeloma cells inhibit non-canonical wnt co-receptor ror2 expression in human bone marrow osteoprogenitor cells: effect of wnt5a/ror2 pathway activation on the osteogenic differentiation impairment induced by myeloma cells

Multiple myeloma (MM) is characterized by the impaired osteogenic differentiation of human mesenchymal stromal cells (hMSCs). Canonical Wnt signaling is critical for the regulation of bone formation, however, recent evidence suggests that the non-canonical Wnt agonist Wnt5a stimulates human osteoblastogenesis through its co-receptor Ror2. The effects of MM cells on non-canonical Wnt signaling and the effect of the activation of this pathway on MM-induced osteoblast exhaustion are not known and were investigated in this study. We found that the osteogenic differentiation of bone marrow hMSCs toward osteoprogenitor cells (PreOB) significantly increased Ror2 expression, and that MM cells inhibit Ror2 expression by PreOB in co-culture by inhibiting the non-canonical Wnt5a signaling. The activation of the non-canonical Wnt pathway in hMSCs by means of Wnt5a treatment and the overexpression of Wnt5 or Ror2 by lentiviral vectors increased the osteogenic differentiation of hMSCs and blunted the inhibitory effect of MM in co-culture. Consistently, Wnt5a inhibition by specific small interfering RNA reduced the hMSC expression of osteogenic markers. Our findings demonstrate that the Wnt5a/Ror2 pathway is involved in the pathophysiology of MM-induced bone disease and that the activation of the non-canonical Wnt5a/Ror2 pathway in hMSCs increases osteogenic differentiation and may counterbalance the inhibitory effect of MM cells.

Experience of vaccination against invasive bacterial diseases in Veneto region (north east Italy)

The goal of this study was to describe and comment the experience of the Veneto Region in the bacterial invasive disease. Vaccination coverage was 93% against pneumococcus and 95% against haemophilus influenzae type B. Regard to meningococcus C the coverage rate was 90.1% In children, 81% at 6 years of age and 78.2% at 15 years. The preliminary data of an active surveillance of invasive bacterial diseases show that the Streptoccoccus pneumoniae was the main agent involved and that its consequences were particularly serious in elderly subjects. With regard to Neisseria meningitidis, we observed a substantial reduction in the number of cases due to serogroup C and a concomitant rise in the percentage of cases due to serogroup B. The suspension of mandatory vaccination should be maintained, the monitoring of vaccination coverage and the active surveillance proved to be a very good assessment tools.

Epidemiological surveillance of West Nile neuroinvasive diseases in Italy, 2008 to 2011

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Epidemiological surveillance of West Nile neuroinvasive diseases in Italy, 2008 to 2011

We describe the geographical and temporal distribution of West Nile neuroinvasive diseases (WNND) cases in Italy from 2008 to 2011. The increasing number of confirmed human cases from eight in 2008 to 18 in 2009 and the occurrence of the virus in a larger geographical area in 2009 (moving from east to west) prompted the Ministry of Health to publish, in spring 2010, a national programme for WNND human surveillance, comprising veterinary and vector surveillance. Subsequently, in 2011, a new national plan on integrated human surveillance of imported and autochthonous vector-borne diseases (chikungunya, dengue and West Nile disease) was issued. Between 2008 and 2011, 43 cases of WNND were reported from five regions in Italy with a case fatality rate of 16%. The incidence of WNND during the entire study period was 0.55 per 100,000 population (range: 0.06–0.23 per 100,000). During 2011, two new regions (Friuli-Venezia Giulia and Sardinia) reported confirmed cases in humans. Integrated human, entomological and animal surveillance for West Nile virus is a public health priority in Italy and will be maintained during 2012.

Randomised clinical trial: efficacy of Lactobacillus paracasei-enriched artichokes in the treatment of patients with functional constipation--a double-blind, controlled, crossover study

BACKGROUND

The role of probiotics in the management of constipation is uncertain.

AIMS

To evaluate the effects of probiotic-enriched artichokes on treatment preference, symptom profile and short-chain fatty acid (SCFA) production in constipated subjects when compared with ordinary artichokes.

METHODS

Twenty constipated patients (3M/17F; 38.8 ± 14.4 years) were studied using a double-blind method and a computer-generated randomisation list. Each patient consumed 180 g per day of ordinary artichokes or artichokes enriched with Lactobacillus paracasei IMPC 2.1 for 15 days (daily dose of 2 × 10(10) CFU). Relief of symptoms was evaluated using a visual analogue scale. The stool consistency and symptom profile of patients were investigated using the Bristol stool form chart and the Gastrointestinal Symptom Rating Scale questionnaire (GSRS). SCFA production in faecal samples was evaluated using HPLC.

RESULTS

Eighty per cent of patients preferred probiotic-enriched artichokes to ordinary ones (P = 0.011). Satisfactory relief of symptoms was significantly higher (P = 0.0014) during the probiotic-enriched artichoke period. Bristol chart cluster scores were significantly higher (3.3 ± 1.2, 2.9 ± 1.3 2.2 ± 1.2, baseline, ordinary artichokes and probiotic-enriched ones, respectively; P = 0.009) and GSRS constipation was significantly lower (13.9 ± 0.9, 10.2 ± 0.8, 8.3 ± 0.9; P = 0.032) in the probiotic group compared with the baseline. As for SCFA production, propionic acid was significantly higher (2.2 ± 1.4, 2.1 ± 1.53, 1.5 ± 1.2; P = 0.035) in the probiotic group compared with baseline.

CONCLUSION

This trial shows a positive effect on symptoms in constipated patients after intake of probiotic-enriched artichokes.

[Increasing childhood immunization coverage by establishing structured relationships with pediatricians and family practitioners]

An immunization strategy can take advantage of various tools, among which the pediatrician and family practitioner These figures, have been assigned the role of accompanying the child and his/her family throughout development. One of the objectives of this role is also to take a major part in the support of immunization coverage of infants, especially in light of the sospension of required immunizations in the Veneto Region. For this reason it is necessary to open dialogue on immunizations together with pediatricians and family physicians. In addition, training of these professional figures, together with healtcare operators who work in the immunization clinics, has allowed the formation and standardization of the network, as the persons who attend the immunization clinics are no longer passive users but persons who require information exchange in order to make an informed choice about immunizations for their children. Surveillance of vaccination coverage is a useful tool for evaluating the trend in vaccination refusals, and in particular it takes into consideration the motivation behind the refusal to adhere to the polio vaccine recommendations even if for now the coverage is maintained above 95%. Concluding, another strong point for the immunization program is "Genitori Più" which finds its continuity with the Regional Prevention Plan.

[Increasing immunization coverage by intervening on determinants of refusal]

With the regional decree 3664/2008, the Veneto Region adopted measures for improvements in the immunization program, among which the "Investigation into determinants for vaccine refusal in the Veneto Region", entrusted by the Department of Prevention Local Health Unit 20 (Ulss 20) of Verona. The objective of the study was to understand which type of parent that accessed immunization services (total adherent, partial adherent or complete refusals) and what factors lead to their choice regarding immmunizations in order to better plan strategies to maintain vaccination coverage.