Expansion of the Alveolar Bone Crest with Ultrasonic Surgery Device: Clinical Study in Mandible

The purpose of this paper was to document the application to the split-crest mandibular procedure in two stage in order to avoid cortical resorption due to periosteal detachment in buccal cortical bone of the alveolar crest. Twenty-two healthy patients with non-contributory past medical history (14 women and 8 men, all non-smokers, mean age 59 years, range 54–65 years) were included in this study. After buccal mucoperiosteal flap was followed by a sagittal corticotomy in the coronal area of the alveolar crest and a second sagittal corticotomy, but in a lower (basal) position and two vertical corticotomies in the buccal wall, using a ultrasonic surgery device (Surgysonic, Esacrom, Imola Italy). Adequate crest expansion was achieved without compromising cortical vascularisation by utilising a combination of scalpel, thin chisels and threaded osteotomes (Bone System, Milano, Italy). Postoperative results were assessed by panoramic and periapical radiographs. Ossification of the osteotomy lines was evident and could be observed as sites with increasing radiopacity on panoramic and periapical radiographs 3 months after implants insertion. No dehiscence of the mucosa was observed. No patient suffered from hypoaesthesia. The mean horizontal bone increase in coronal area was 5±3 mm. Mandibular ridge expansion using a split-crest technique that included grafting the implant sites with a ultrasonic surgery device is a viable therapeutic alternative for implant placement in this patient population.

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.

Direct Visualization of Oral-Cavity Tissue Fluorescence as Novel Aid for Early Oral Cancer Diagnosis and Potentially Malignant Disorders Monitoring

Direct visualization of the oral tissue autofluorescence has been recently reviewed in several studies as a possible adjunctive tool for early recognition and diagnosis of potentially malignant and malignant oral disorders. The aims of this study were to assess: a) the value of a simple handheld device for tissue auto-fluorescence visualization of potentially malignant oral lesions; and b) the sensitivity, specificity and diagnostic accuracy of tested device, using histological examination as the gold standard. 175 consecutive patients, with at least one clinical oral lesion, were enrolled in the study. Clinical conventional inspections were performed for each patient by two blind operators. Then, oral biopsy and histological examination were performed. Pathologist was blind with respect to the autofluorescence results. The 175 histological assessments revealed no dysplasia, mild dysplasia, moderate/severe dysplasia and OSCC, in the 67.4%, 8.6%, 8%, 16% of cases, respectively. Oral lesions diagnosed as OSCC were found as positive under fluorescent light in the 96.4% of cases. Statistically significant correlation was observed between oral dysplastic lesions and the loss of tissue fluorescence (p-value=0.001). Low sensitivity values (60% and 71%) were recorded about the ability of the device in differentiating mild dysplasia vs. lack of dysplasia and moderate/severe dysplasia vs absence of dysplasia, respectively. The device tested in our study was found to not replace the histopathology procedure. However, we assessed its usefulness for oral tissue examination, especially within an oral medicine secondary care facility, before performing a biopsy and in monitoring oral lesions.

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.

Analysis and Structural Examination of Screw Loosening in Oral Implants

Biological and technical failures of implants have already been reported. Mechanical factors are certainly of importance in implant failures, even if their exact nature has not yet been established. The abutment screw fracture or loosening represents a rare, but quite unpleasant failure. The aim of the present research is an analysis and structural examination of screw thread or abutment. In this study broken screws were excluded. A total of 58 screw thread loosening were observed, 5 Branemark, (Nobel Biocare, Gothenburg, Sweden) 4 Implant Innovation (Riverside Drive Palm Beach Gardens, FL, USA) and 7 Restore (Lifecore Biomedical, Chaska, Minnesota, USA) and 42 T.B.R. implant (Benax, Ancona, Italy). The loosened abutment screws were retrieved and analyzed under SEM. Many alterations and deformations were present in concavities and convexities of screw threads.

A case report of a difficult dissection of the iliac vessels conducted by means of the harmonic scalpel during a kidney transplantation

BACKGROUND

The "difficult" preparation of iliac vessels in the kidney transplant recipient caused by a perivascular fibrosis with satellite lymphadenopathy is sometimes burdened by post-transplant complications (lymphocele, seroma and hematoma). Both iliac vascular adhesions and satellite lymphoadenopaty are often due to reiterate femoral cannulation aimed to hemodialysis.

PATIENTS AND METHODS

The case report concerns a 60 years old female uremic patient, on dialysis for about 4 years with perivascular fibrosis and pelvic lymphadenopathy caused by bilateral femoral artery catheterization. In the course of kidney transplant, preparation of the iliac vessels was performed by ultrasonic scalpel. In the case we handled there was no incidence of immediate, medium and long term post operative complications, with a considerable reduction of the operative time in the vascular dissection performed without ligation. Often the long dialytic period, the same nephropathy, reiterative femoral catheterization determine perivascular fibrosis and/or consensual lymphadenopathy. In these cases, in light of initial experience, the use of ultrasonic scalpel enables easy dissection by the coagulative synthesis not only of vascular compartment but also of the lymphatic duct whose leakage, particularly in these cases, creates a favourable condition to hematoma and/or lymphocele formation. These complications, although rarely jeopardize patient's life, however, may affect the outcome of transplantation in terms of morbidity and survival of the organ. The use of ultrasonic scalpel ensures total control of vascular and lymphatic compartment coagulation, alongside a reduction in the time of surgical dissection.

A simple method to treat post-kydney transplantation lymphocele

To describe our experience with ultrasonic-guided instillation of povidone-iodine to treat post-kidney transplantation lymphocele. Patients and methods. We studied the safety and efficacy of this procedure for treatment of lymphocele in 6 male kidney transplanted recipients in which we assisted a progressive increase of creatinine and urinary proteins levels and color-Doppler ultrasonography demonstrated an increase (25,4%) of index of resistence (IR) Using eco-colorDoppler, the related-graft lymphocele location and the distance to the anterior abdominal wall were determined; then, a radiopaque double-lumen catheter was used to instillate 5% povidone-iodine 10 ml. Results. Percutaneous drainage achieved a resolution rate of 100%. Studying the rate of peripheral and internal vascularization of the kidney before and after treatment, eco-colorDoppler showed a significant decrease of the IR (24,6%). Conclusions. The US-guided povidone-iodine instillation for treatment of lymphocele following renal transplantation may be considered as first choice therapy in such disease.

Esomeprazole-induced hyperchromograninemia in the absence of concomitant hypergastrinemia

BACKGROUND

A 37-year-old female, who had a neuroendocrine pancreatic neoplasm, underwent duodeno-cephalo-pancreatectomy. In the 2 years following surgery, she had normal levels of serum chromogranin A (CgA), gastrin and other tumor markers. About 3 years after surgery, owing to the onset of reflux-like dyspeptic symptoms, the patient started treatment with the PPI esomeprazole. During PPI treatment, the patient's serum CgA level rose to more than three times the upper limit of normal, although her gastrin levels remained in the normal range. These findings were interpreted as being suggestive of neuroendocrine tumor relapse.

INVESTIGATIONS

Thoraco-abdominal CT, In¹¹¹-octreotide total body scan, CT of sella turcica, Tc(99m)-sestamibi neck scan, mutational analysis of chromosome 11q13 (site of multiple endocrine neoplasia type 1 [MEN1] gene). Discontinuation of, and rechallenge with, esomeprazole.

DIAGNOSIS

Esomeprazole-induced hyperchromograninemia in the absence of elevated levels of fasting serum gastrin.

MANAGEMENT

Discontinuation of acid-suppressive treatment and continuation of oncologic follow-up.

Bilateral posterior maxillary segmental osteotomy to rehabilitate edentulous mandibular area: case report

The purpose of this work was to describe a clinical case with reduced vertical height in both the posterior sectors, due to maxillary dento-alveolar extrusion in mandibular edentulous space, as a result of some extractions which have not been promptly replaced by a prosthetic rehabilitation, eventually resolved with a bilateral posterior segmental maxillary osteotomy (PMSO). Our surgical technique was practised under general anesthesia according to Kufner's version of Schuchardt's original description. In the light of the present outcomes, in severe clinical cases of dento-alveolar extrusion, the PMSO can be considered the optimal solution, because of the quality and the stability of the final result, the short therapeutic times, the limited morbidity and the modest compliance asked to the patient.

Risk factors for type 2 diabetes in women attending menopause clinics in Italy: a cross-sectional study

OBJECTIVE

To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause.

SUBJECTS

Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms.

METHODS

Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year.

RESULTS

Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged < 50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women aged > or = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73).

CONCLUSIONS

This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

Lack of association between common polymorphisms of epidermal growth factor receptors and nonsyndromic cleft lip with or without cleft palate

OBJECTIVES

Nonsyndromic cleft lip with or without cleft palate (CL/P) is a frequent craniofacial malformation with a complex aetiology. Since the first report of an association between DNA sequence variants at the transforming growth factor alpha gene (TGFA) and nonsyndromic oral clefts, several studies have been carried out, which have produced conflicting results. Overall, TGFA is considered as a genetic clefting modifier in humans. Murine models indicate that the Tgfa product (tgfalpha), as well as its receptor (Egfr), actively participates in palate development. Notably, Egfr null mice showed an increased incidence in orofacial clefts. In the present study, genes which code for subunits of epidermal growth factor receptors (EGFRs) have been considered as candidate genes for CL/P.

METHODS

A family based investigation was performed using a sample of 239 case/parent triads. The aim was to test for an allelic association between common non-synonymous polymorphisms in EGFR genes and CL/P.

RESULTS AND CONCLUSION

The results did not suggest any evidence of a link between the investigated polymorphisms and CL/P, however the involvement of different polymorphisms or mutations in such genes cannot be excluded.

Safety, efficacy, and time to clinical response with bevacizumab plus FOLFIRI regimen in metastatic colorectal cancer

e15138

Background: Bevacizumab (BEV) has shown clinical activity in metastatic colorectal cancer patients (mCRC)and randomised phase III trials have demonstrated that this agent significantly improves overall and/or progression-free survival when added to first-line irinotecan based chemotherapy (CT) regimens. We evaluated the efficacy and safety of BEV plus FOLFIRI (irinotecan, 5- fluorouracil, and leucovorin) as first line treatment in 27 consecutive metastatic colorectal cancer cases, with the primary end point to calculate the median time to clinical response with this chemotherapeutic schedule. Methods: Between October 2007 and January 2008 we collected the data on 27 patients with mCRC treated with first line chemotherapy with BEV plus FOLFIRI. Elegibility criteria had to be: mCRC; no prior CT for metastatic disease; ECOG PS 0/1, adequate organ function; no CNS metastases. The treatment consisted of a minimum of six cycles of irinotecan plus infusional 5-FU/LV according to the classical FOLFIRI schedule; BEV (5mg/kg) was given on day 1 with CT and then every 2 weeks until disease progression. Safety and response were assessed at the time of first CT and every 4 weeks thereafter. Results: 27 pts were evaluable (male 18; median age 61 years (range 45–77), ECOG PS 0: 52%, PS 1: 48%. The sites of metastases were: liver (15 pts), lung (5 pts), liver and lung (5 pts), peritoneal wall (2 pts).Median follow-up was 18 weeks. Two patients had complete response(CR) and 13 pts partial response (PR), with an overall response rate of 57.7%. Five patients had stable disease and 6 patients showed progressive disease. A clinical benefit was demonstrated in 77 % of pts. We observed a median time to clinical response of 11 weeks, evaluated with tumor markers and with CT/NMR/US examinations. A grade 3 or 4 neutropenia was detected in 39% of pts and grade 2 or 3 hypertension in 9%. We did’nt observe cases of thrombosis, bleeding and gastrointestinal perforation, sometimes related to the use of BEV. Conclusions: In this little experience the efficacy and safety of BEV associated with FOLFIRI schedule, a first line therapy in mCRC,is consistent with results from other previous studies, showing moreover a short time to clinical response with this association.

No significant financial relationships to disclose.

[Treatment of a wide cutaneous post-traumatic loss of substance by cell cultures. Case report]

Bioengineering skin represents a successful outcome in the interdisciplinary research applied to reconstructive surgery. In this study we report our experience in the reconstruction of a wide traumatic wound by autologous engineered skin, grown on a biomaterial scaffold. Advantages were rapid reparation of the trauma and good scars.

A study of 17 patients affected with plexiform neurofibromas in upper and lower extremities: comparison between different surgical techniques

Plexiform neurofibromas (PN) are one of the most common and severe types of neurofibroma that occur in neurofibromatosis type I. These tumours affect long portions of nerves, infiltrating the nerve and surrounding tissue thus causing significant pain, deformity and functional problems in the affected part of the body. Treatment of this variant of neurofibromas is currently surgical. The aim of this study was to analyze the surgical treatment of plexiform neurofibromas in the lower and upper extremities. The clinical pathological features of 29 neurofibromas, 12 in the upper extremities and 17 in the lower extremities, as diagnosed at the Department of Plastic and Reconstructive Surgery of University "La Sapienza" in Rome from 2000 to 2007, were reviewed. We established that subtotal and total resection without functional destruction is often possible for superficial PN.

The sea urchin embryo: a model to study Alzheimer's beta amyloid induced toxicity

Alzheimer's disease (AD) is the most common form of dementia. The cause of AD is closely related to the accumulation of amyloid beta peptide in the neuritic plaques. The use of animal model systems represents a good strategy to elucidate the molecular mechanism behind the development of this pathology. Here we use the Paracentrotus lividus embryo to identify molecules and pathways that can be involved in the degenerative process. As a first step, we identified the presence of an antigen related to the human APP, called PlAPP. This antigen, after gastrula stage, is processed producing a polypeptide of about 10kDa. By immunohistochemistry we localized the PlAPP antigen in some serotonin expressing cells. Similarly, after 48 or 96h incubation, a recombinant beta-amyloid peptide, rAbeta42, accumulates around the intestinal tube and oesophagus. In addition, incubation of sea urchin embryos with two different solutions rich in oligomers and fibrillar aggregates of rAbeta42 induce activation of apoptosis as detected by TUNEL assay. Moreover, we demonstrate that aggregates induce apoptosis by extrinsic pathway activation, whereas oligomers induce apoptosis both by extrinsic and intrinsic pathway activation. Utilizing an apoptotic inhibitor, caspases activation was offset and morphological damage rescued. Taken together all these observations suggest that the sea urchin may be a simple and suitable model to characterize the mechanism underlining the cytotoxicity of Abeta42.

Anomalous levels of Cl- transporters in the hippocampal subiculum from temporal lobe epilepsy patients make GABA excitatory

The mRNA levels of NKCC1, an inwardly directed Na(+), K(+)-2Cl(-) cotransporter that facilitates the accumulation of intracellular Cl(-), and of KCC2, an outwardly directed K(+)-Cl(-) cotransporter that extrudes Cl(-), were studied in surgically resected brain specimens from drug-resistant temporal lobe (TL) epilepsy (TLE) patients. Quantitative RT-PCR analyses of the mRNAs extracted from the human TLE-associated brain regions revealed an up-regulation of NKCC1 mRNA and a down-regulation of KCC2 mRNA in the hippocampal subiculum, compared with the hippocampus proper or the TL neocortex, suggesting an abnormal transcription of Cl(-) transporters in the TLE subiculum. In parallel experiments, cell membranes isolated from the same TLE-associated brain regions were injected into Xenopus oocytes that rapidly incorporated human GABA(A) receptors into their surface membrane. The GABA currents elicited in oocytes injected with membranes from the subiculum had a more depolarized reversal potential (E(GABA)) compared with the hippocampus proper or the neocortex. The NKCC1 blocker bumetanide or a temperature decrease of 10 degrees C shifted the GABA-current E(GABA) more negative in oocytes injected with membranes from TLE hippocampal subiculum, matching the E(GABA) of TL neocortex-injected oocytes. We conclude that the anomalous expression of both Cl(-) transporters, NKCC1 and KCC2 [corrected] in TLE hippocampal subiculum probably causes altered Cl(-) transport in the "epileptic" neurons, as revealed in the microtransplanted Xenopus oocytes, and renders GABA aberrantly "exciting," a feature that may contribute to the precipitation of epileptic seizures.

Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy

OBJECTIVE

To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy.

METHODS

Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper.

RESULTS

The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms.

CONCLUSIONS

This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

Determination of 1-phenylazo-2-naphthol (Sudan I) in chilli powder and in chilli-containing food products by GPC clean-up and HPLC with LC/MS confirmation

A simple and rapid method is reported for the routine determination 1-phenylazo-2-naphthol (Sudan I) in chilli powder and in chilli-containing food products. The method involved Soxtec extraction from the products followed by high-pressure gel permeation chromatographic clean-up collecting the appropriate fraction. Analysis of this fraction was by HPLC with UV/VIS detection. The limit of detection was 7 microg kg(-1) and the limit of quantification was 13 microg kg(-1). The identity of Sudan I in food products was established by electrospray LC/MS with MS/MS confirmation. From a small survey of 30 retail samples, 11 samples of crushed chilli, Italian pasta, chilli-snack and vegetable sauce contained levels of Sudan I ranging from 24 to 5591 microg kg(-1).

Phosphatase inhibitors remove the run-down of gamma-aminobutyric acid type A receptors in the human epileptic brain

The properties of gamma-aminobutyric acid (GABA) type A receptors (GABA(A) receptors) microtransplanted from the human epileptic brain to the plasma membrane of Xenopus oocytes were compared with those recorded directly from neurons, or glial cells, in human brains slices. Cell membranes isolated from brain specimens, surgically obtained from six patients afflicted with drug-resistant temporal lobe epilepsy (TLE) were injected into frog oocytes. Within a few hours, these oocytes acquired GABA(A) receptors that generated GABA currents with an unusual run-down, which was inhibited by orthovanadate and okadaic acid. In contrast, receptors derived from membranes of a nonepileptic hippocampal uncus, membranes from mouse brain, or recombinant rat alpha 1 beta 2 gamma 2-GABA receptors exhibited a much less pronounced GABA-current run-down. Moreover, the GABA(A) receptors of pyramidal neurons in temporal neocortex slices from the same six epileptic patients exhibited a stronger run-down than the receptors of rat pyramidal neurons. Interestingly, the GABA(A) receptors of neighboring glial cells remained substantially stable after repetitive activation. Therefore, the excessive GABA-current run-down observed in the membrane-injected oocytes recapitulates essentially what occurs in neurons, rather than in glial cells. Quantitative RT-PCR analyses from the same TLE neocortex specimens revealed that GABA(A)-receptor beta 1, beta 2, beta 3, and gamma 2 subunit mRNAs were significantly overexpressed (8- to 33-fold) compared with control autopsy tissues. Our results suggest that an abnormal GABA-receptor subunit transcription in the TLE brain leads to the expression of run-down-enhanced GABA(A) receptors. Blockage of phosphatases stabilizes the TLE GABA(A) receptors and strengthens GABAergic inhibition. It may be that this process can be targeted to develop new treatments for intractable epilepsy.

Lack of burning and stinging from a novel first-aid formulation applied to experimental wounds

Antiseptic-anesthetic first aid formulations typically produce a burning or stinging sensation when used on wounds. The aim of this study was to assess the lack of sting/burn potential of a prototype first-aid wipe when applied to superficial wounds. This was a one-day, double-blind, randomized study, evaluating the stinging/burning sensation from a prototype first-aid wipe with a cellulose base containing 1.0% pramoxine HCL and 0.13% benzalkonium chloride. The study followed a direct comparison test design of four test formulations. The remaining three articles were: (a) sterile 0.9% sodium chloride (no-sting/no-burn control), (b) 3% hydrogen peroxide (first-aid sting/burn control), and (c) 70% isopropyl alcohol (second sting/burn control). The test was performed on 24 subjects. The tape stripping method was used to create four standardized wounds on the volar forearms, reaching the glistening layer. Each test article was applied to the wound for 15 seconds. The subjects were asked to report the intensity of the stinging/burning sensation during the application. The prototype pramoxine-benzalkonium chloride wipe produced significantly less stinging/burning than both 70% isopropyl alcohol and 3% hydrogen peroxide. Also, the prototype wipe did not produce more stinging and burning in superficial wounds compared to the saline control.

Long-term kidney transplant outcomes in patients receiving oil-based or microemulsion formulations of cyclosporine

In the last 20 years long-term experience with cyclosporine use in kidney transplantation has increased, allowing a more precise identification of its benefits.

METHODS

We performed a retrospective analysis of 1619 kidney transplants that received cyclosporine-based immunosuppressive therapy. Patients were divided into three groups (1) oil-based cyclosporine (SIM) with trough monitoring (GI, n=617); (2) microemulsion formulation (NEO) with trough monitoring (GII, n=962); and (3) NEO with C2 monitoring (GIII, n=40). Information was obtained on transplant demography; adjunctive immunosuppressive agent; living (LD) versus cadaveric (CAD) recipients; delayed graft function; any treated acute rejection; graft function at 3, 6, and 12 months, patient and graft survival, as well as causes of graft loss and death.

RESULTS

At 15 years follow-up, patient and graft survival were 67.5% and 41.6%, being superior, among LD versus CAD recipients (patient: 78.7% vs 57.7%, P<.001; graft: 56.4% vs 30.5%, P<.001). In LD (54% vs 32%, P<.001) and CAD (69% vs 55%, P<.001) NEO reduced the incidence of AR and improved 8-year patient (LD: 81.8% vs 94.7%; CAD: 66.4 vs 79.9%, P<.01) and graft survival (LD: 58.3 vs. 80%; CAD: 40.2% vs. 59.5%, P<.01), compared to SIM. Overall 8-year graft survival was inferior among patients with increased 1-year creatinine values (< or =1.5, 1.6-2.5 and >2.5 mg/dL) level (74% vs 63.9% vs 22.4%, P<.001) or change in Cr (< or =0.1, 0.2-0.4, >0.5 mg/dL) level (73.1% vs 61.9% vs 37.2%, P<.001). In patients at the same level of graft function, those receiving NEO showed superior 8-year patient and graft survival compared with SIM.

CONCLUSION

Compared to SIM, NEO reduced the incidence of acute rejection and produced superior long-term patient and graft survival.

Transpupillary retinopexy of chorioretinal lesions predisposing to retinal detachment with the use of diode (810 nm) microlaser

PURPOSE

To evaluate the clinical efficacy and safety of diode microlaser for transpupillary retinopexy in eyes with retinal degenerations and retinal tears in a prospective clinical study.

METHODS

Twenty eyes (19 patients) with mid or peripheral degenerations and retinal tears were treated with infrared diode photocoagulation. A continuous-wave diode laser was used to create clinically just visible chororetinal bums. The follow-up period was extended to 3 months. Color photographs of the coagulated retina were taken 24 hours after laser retinopexy and at 1 month and 3 months postoperatively.

RESULTS

Acute chorioretinal burns appeared gray-white on the midperiphery, not sharply defined and sometimes somewhat difficult to detect during photocoagulation. Power levels ranged from 110 to 640 mW (mean +/- SD 384+/-133.47 mW). In eyes with dark brown irises, the mean laser power was significantly lower than in eyes with blue-green irises (325.83+/-117.90 mW versus 471.25+/-109.60 mW, P < 0.05). At the 1 -month postoperative follow-up examination, all eyes showed chororetinal scarring with pigmentary mottling. At 3 months, the diode lesions' appearance was that of a marked atrophic chonoretinal scar. There were no adverse side effects in the laser-treated eyes except for a small choroidal-retinal-vitreal bleeding in 1 (5%) of the eyes.

CONCLUSIONS

Transpupillary photocoagulation to mid or peripheral retina with diode microlaser has proven to be effective at providing retinopexy of retinal degenerations and retinal tears. The long wave 810 nm can also be used successfully and safely for the prophylaxis of retinal detachment because it can create a strong adhesion between the retina and choroid. However, diode laser should not be employed routinely for treating patients with clear media or fundus hypopigmentation. The use of diode is preferably indicated in eyes with media opacities because infrared light has the advantage of a better transmission through lens opacity or vitreous hemorrhage. As diode laser energy can produce variable tissue effects, there may be some difficulty in obtaining reproducible bums because of unpredictable changes in melanin density of the retinal pigment epithelium and choroid.

The sea urchin sns insulator blocks CMV enhancer following integration in human cells

Insulators are a new class of genetic elements that attenuate enhancer function directionally. Previously, we characterized in sea urchin a 265-bp-long insulator, termed sns. To test insulator activity following stable integration in human cells, we placed sns between the CMV enhancer and a tk promoter upstream of a GFP transgene of plasmid or retroviral vectors. In contrast to controls, cells transfected or transduced with insulated constructs displayed a barely detectable fluorescence. Southern blot and PCR ruled out vector rearrangement following integration into host DNA; RNase protection confirmed the enhancer blocking activity. Finally, we demonstrate that two cis-acting sequences, previously characterized in sea urchin, are also specific binding sites for human proteins. We conclude that sns interferes with enhancer promoter interaction also in a human chromatin context. The relatively small size, evolutionary conservation and apparent lack of enhancer specificity might result useful in gene transfer experiments in human cells.

Homeobox genes and sea urchin development

We describe the expression of three Paracentrotus lividus homeobox-containing genes of the dispersed class during sea urchin embryogenesis and discuss their possible roles in the mechanisms of cell specification and embryo morphogenesis. PlHbox12 represents the first regulator identified in sea urchin that belongs to the zygotic class of transcription factors. Its early and transient expression and the localization of transcripts suggests that PlHbox12 is involved in cell fate specification of the oral or aboral ectodermal territories at the early cleavage stages. PlHbox9 is expressed just after the completion of gastrulation in a narrow stripe of cells at the ectoderm-endoderm boundary. It probably organizes a novel spatial boundary which definitely separates the archenteron and the aboral ectoderm. Finally, the spatial and temporal expression of the PlOtp gene strongly indicate that this regulator is conditionally activated in few cells of the oral ectoderm and is involved in patterning of this territory at late stages. Furthermore, our data indicate that PlOtp acts upstream of signaling systems that lead to the activation of the primary mesenchyme cell gene expression program and skeletal morphogenesis.

Functional characterization of the enhancer blocking element of the sea urchin early histone gene cluster reveals insulator properties and three essential cis-acting sequences

Insulator elements can be functionally identified by their ability to shield promoters from regulators in a position-dependent manner or their ability to protect adjacent transgenes from position effects. We have previously reported the identification of a 265 bp sns DNA fragment at the 3' end of the sea urchin H2A early histone gene that blocked expression of a reporter gene in transgenic embryos when placed between the enhancer and the promoter. Here we show that sns interferes with enhancer-promoter interaction in a directional manner. When sns is placed between the H2A modulator and the inducible tet operator, the modulator is barred from interaction with the basal promoter. However, the tet activator (tTA) can still activate the promoter, even in the presence of sns, demonstrating that sns does not interfere with activity of a downstream enhancer. In addition, the H2A modulator can still drive expression of a divergently oriented transcription unit, suggesting that sns does not inhibit binding of transcription factor(s) to the enhancer. To identify cis-acting sequence elements within sns which are responsible for insulator activity, we have performed in vitro DNase I footprinting and EMSA analysis, and in vivo functional assays by microinjection into sea urchin embryos. We have identified three binding sites for protein complexes: a palindrome, a direct repeat, and a C+T sequence that corresponds to seven GAGA motifs on the transcribed strand. Insulator function requires all three cis-acting elements. Based on these results, we conclude that sns displays properties similar to the best characterized insulators and suggest that directional blocking of enhancer-activated transcription by sns depends on the assembly of distinct DNA-protein complexes.

Routine use of external cephalic version in three hospitals

BACKGROUND

External cephalic version has been advocated as a safe alternative to vaginal breech delivery or cesarean birth. The purpose of this study was to determine the efficacy of routine use of external cephalic version at 36 weeks or more of gestation in three different levels of hospitals.

METHODS

External cephalic version was performed on 923 women with a single breech fetus at three hospitals in Italy. The procedure was attempted with a tocolytic agent for uterine relaxation and with no maternal analgesia. The version technique adopted was the "forward roll."

RESULTS

Version was successfully performed on 579 fetuses (62.7%); each hospital had a similar success rate, and 56.9 percent of the women delivered vaginally. The procedure was more successful in multiparas and in women with an incomplete type of breech, polyhydramnios, and posterior localization of the placenta. Vaginal bleeding was experienced by 14 women; eight cesarean sections were performed for suspected abruptio placentae, confirmed in four cases. Two cephalic-turned fetuses experienced an episode of persistent bradycardia and were turned again to breech; in five cases a nonstress test recorded after the version showed repeated variable decelerations and in one case a cesarean section was performed. Neonatal outcomes were good in 922 infants. A fracture of the femur attributable to the version was observed in one newborn.

CONCLUSIONS

External cephalic version is effective in reducing the number of cesarean deliveries in term breech infants in different obstetric settings, with no major neonatal adverse outcomes.

Constitutive hsp70 is essential to mitosis during early cleavage of Paracentrotus lividus embryos: the blockage of constitutive hsp70 impairs mitosis

Localization of constitutive hsp70 in eggs and early embryos of sea urchin Paracentrotus lividus is shown by means of in situ immunostaining. An accumulation of this protein is shown in the mitotic structures (asters, spindles and centrosomes). Microinjection of anti-hsp70 antibodies into eggs causes impairment of formation of mitotic structures and of cell division. This impairment goes from a complete mitotic block, to irregular mitotic apparatus formation with irregular cleavage, depending upon the antibody concentration. The localization of hsp70 after antibody microinjection is also described. Blockage of mitotic apparatus formation by nocodazole also blocks the concentration of hsp70 molecules observed in nontreated eggs. That the constitutive hsp70 plays a role in sea urchin mitosis is indicated.

Spatially restricted expression of PlOtp, a Paracentrotus lividus orthopedia-related homeobox gene, is correlated with oral ectodermal patterning and skeletal morphogenesis in late-cleavage sea urchin embryos

Several homeobox genes are expressed in the sea urchin embryo but their roles in development have yet to be elucidated. Of particular interest are homologues of homeobox genes that in mouse and Drosophila are involved in patterning the developing central nervous system (CNS). Here, we report the cloning of an orthopedia (Otp)-related gene from Paracentrotus lividus, PlOtp. Otp is a single copy zygotic gene that presents a unique and highly restricted expression pattern. Transcripts were first detected at the mid-gastrula stage in two pairs of oral ectoderm cells located in a ventrolateral position, overlying primary mesenchyme cell (PMC) clusters. Increases in both transcript abundance and the number of Otp-expressing cells were observed at prism and pluteus stages. Otp transcripts are symmetrically distributed in a few ectodermal cells of the oral field. Labelled cells were observed close to sites of active skeletal rod growth (tips of the budding oral and anal arms), and at the juxtaposition of stomodeum and foregut. Chemicals known to perturb PMC patterning along animal-vegetal and oral-aboral axes altered the pattern of Otp expression. Vegetalization by LiCl caused a shift in Otp-expressing cells toward the animal pole, adjacent to shifted PMC aggregates. Nickel treatment induced expression of the Otp gene in an increased number of ectodermal cells, which adopted a radialized pattern. Finally, ectopic expression of Otp mRNA affected patterning along the oral-aboral axis and caused skeletal abnormalities that resembled those exhibited by nickel-treated embryos. From these results, we conclude that the Otp homeodomain gene is involved in short-range cell signalling within the oral ectoderm for patterning the endoskeleton of the larva through epithelial-mesenchymal interactions.

Regulation of the sea urchin early H2A histone gene expression depends on the modulator element and on sequences located near the 3' end

Transcription of the sea urchin early histone genes occurs transiently during early cleavage, reaching the maximum at the morula stage and declining to an undetectable level at the gastrula stage. To identify the regulatory elements responsible for the timing and the levels of transcription of the H2A gene, we used promoter binding studies in nuclear extracts and microinjection of a CAT transgene driven by the early H2A promoter. We found that morula and gastrula nuclear proteins produced indistinguishable DNase I footprint patterns on the H2A promoter. Two sites of interactions, centred on the modulator/enhancer and on the CCAAT box respectively, were detected. Deletion of the modulator or coinjection of an excess of modulator sequences severely affected the expression of two transgenes driven by the enhancer-less and modulator-containing H2A promoter. Finally, a DNA fragment containing 3' coding and post-H2A spacer sequences, where upon silencing three micrococcal nuclease hypersensitive sites were previously mapped, specifically repressed at the gastrula stage the expression of the transgene driven by the H2A promoter. These results indicate that the modulator is essential for the expression of early H2A gene and that sequences for downregulation are localized near the 3' end of the H2A gene.

Highly restricted expression at the ectoderm-endoderm boundary of PIHbox 9, a sea urchin homeobox gene related to the human HB9 gene

Characterisation of a sea urchin (P. lividus) homeobox gene PIHbox 9 is reported. The homeodomain of PIHbox9 is 95% identical to the homeodomain of the human HB9 gene, indicating that the two genes are highly related. Temporal expression analysis during sea urchin embryogenesis showed an absence of transcripts at early cleavage stages. At late gastrula stage, transcripts were barely detectable and reached the highest abundance at prism/early pluteus stages. By whole mount in situ hybridisation we observed a highly restricted expression in a few cells of the ectoderm-endoderm boundary of embryos at the prism stage. At pluteus stages, expression of PIHbox 9 was confined around the anus.

Sea urchin HSF activity in vitro and in transgenic embryos

Evidence is provided for the presence at the physiological temperature of 20 degrees C of a heat shock transcriptor factor, HSF, in the nuclei of P.lividus embryos. This HSF is able to specifically bind in vitro the heat shock element, HSE, of the promoter of the hsp70 gene i.v., as suggested by DNA-protein binding reactions and DNAse I protection assays. Upon heat-shock, at the temperature of 31 degrees C, its ability to bind the HSE units becomes much higher. The HSF activated by heat-shock drives in vivo the transcription of the beta-galactosidase reporter gene in transgenic sea urchin gastrulae. An ATF-like transcription factor, widely described in other organisms but not at all in sea urchins, is also present in the nuclear extracts and is able to bind the consensus individuated in the hsp70 i.v. gene promoter.

Enhancer blocking activity located near the 3' end of the sea urchin early H2A histone gene

The sea urchin early histone repeating unit contains one copy of each of the five histone genes whose coordinate expression during development is regulated by gene-specific elements. To learn how within the histone repeating unit a gene-specific activator can be prevented to communicate with the heterologous promoters, we searched for domain boundaries by using the enhancer blocking assay. We focused on the region near the 3' end of the H2A gene where stage-specific nuclease cleavage sites appear upon silencing of the early histone genes. We demonstrated that a DNA fragment of 265 bp in length, defined as sns (for silencing nucleoprotein structure), blocked the enhancer activity of the H2A modulator in microinjected sea urchin embryos only when placed between the enhancer elements and the promoter. We also found that sns silenced the modulator elements even when placed at 2.7 kb from the promoter. By contrast, the enhancer activity of the modulator sequences, located downstream to the coding region, was not affected when sns was positioned in close proximity to the promoter. Finally, the H2A sns fragment placed between the simian virus 40 regulative region and the tk promoter repressed chloramphenicol acetyltransferase expression in transfected human cell lines. We conclude that 3' end of the H2A gene contains sequence elements that behave as functional barriers of enhancer function in the enhancer blocking assay. Furthermore, our results also indicate that the enhancer blocking function of sns lacks enhancer and species specificity and that it can act in transient assays.

Homeobox-containing gene transiently expressed in a spatially restricted pattern in the early sea urchin embryo

In the sea urchin embryo, the lineage founder cells whose polyclonal progenies will give rise to five different territories are segregated at the sixth division. To investigate the mechanisms by which the fates of embryonic cells are first established, we looked for temporal and spatial expression of homeobox genes in the very early cleavage embryos. We report evidence that PlHbox12, a paired homeobox-containing gene, is expressed in the embryo from the 4-cell stage. The abundance of the transcripts reaches its maximum when the embryo has been divided into the five polyclonal territories--namely at the 64-cell stage--and it abruptly declines at later stages of development. Blastomere dissociation experiments indicate that maximal expression of PlHbox12 is dependent on intercellular interactions, thus suggesting that signal transduction mechanisms are responsible for its transcriptional activation in the early cleavage embryo. Spatial expression of PlHbox12 was determined by whole-mount in situ hybridization. PlHbox12 transcripts in embryos at the fourth, fifth, and sixth divisions seem to be restricted to the conditionally specified ectodermal lineages. These results suggest a possible role of the PlHbox12 gene in the early events of cell specification of the presumptive ectodermal territories.

Modulator factor-binding sequence of the sea urchin early histone H2A promoter acts as an enhancer element

The sea urchin early H2A histone gene, like the other four members of the repeating units, is transiently expressed during very early development. To investigate the mechanisms underlying the faithful expression of the early H2A gene, we focused our attention on the modulator element. We showed by DNase I cleavage protection patterns that the modulator includes the upstream sequence element 1 (USE1) and mapped at nucleotides -137 to -108 in the early H2A gene promoter. Functional tests conducted by microinjection into sea urchin embryos then showed that the modulator element binds the transcriptional factor called modulator-binding factor 1 (MBF-1). We found in fact that coinjection of an excess of the MBF-1-binding site, either as the modulator or as the USE1, efficiently impaired the activity of the H2A promoter. An unexpected finding was the expression of the reporter gene from the early H2A promoter at the gastrula stage of embryonic development, when the early histone genes are transcriptionally silent. In addition, we also found that the modulator element was active at the gastrula stage. The potential enhancer activity of the modulator was tested by microinjecting several constructs containing single or multiple copies of the modulator element placed 5' or 3' to a thymidine kinase gene (tk) promoter in both sea urchin embryos and Xenopus laevis oocytes and determining the expression of a reporter chloramphenicol acetyltransferase gene under the control of the linked tk promoter. We found that an oligonucleotide bearing the MBF-1-binding site activates the expression of the reporter gene independently of the position and orientation. We conclude that the modulator binds the MBF-1 activator and that it is a transcriptional enhancer of the early H2A histone gene.

[Screening for Salmonella in pregnancy]

National and Regional Health Authorities advise a stool culture in pregnant women before term in order to detect Salmonella carriers, prevent the spread of this microorganism to the newborn and avoid outbreaks of this infection in the nurseries. The Tuscany section of the Italian Association of Obstetricians and Gynecologists decided to test the usefulness of this Salmonella screening. In 7431 pregnant women at the 36th week a stool sample was examined for the presence of Salmonella. The occurrence of diarrhoea in these women was also investigated. The prevalence of Salmonella excretors in our obstetric population was 0.27%. Thirty per cent of the positive women complained of diarrhoea; that means that the risk of being positive in the presence of this symptom is 11.8 times larger. The positive cases were detected essentially in late summer and fall. No nursery outbreak occurred during the period studied. The Salmonella-carrying mother can not take advantage of an effective antimicrobic therapy and a single stool sample allows the detection of only part of the carriers. Therefore screening can not prevent the possibility of transmission during birth. The unfavorable ratio between costs and benefits suggests that stool culture for Salmonella may be useful only in late summer and fall and in symptomatic women. In order to obtain better results in the prevention of infections among newborns the observance of careful hygienic rules in the delivery rooms and in the nurseries is mandatory.

Expression of homeobox-containing genes in the sea urchin (Parancentrotus lividus) embryo

Two homeobox-containing genes that belong to different homeodomain classes have been isolated from a sea urchin genomic library. One, PlHbox11, is the sea urchin homologue of the human and mouse Hox B3 gene, the other, PlHbox12, shows about 55% identity with paired class genes. Expression profile analysis of the two sea urchin Hbox genes suggests that they play different roles during embryogenesis. In fact, PlHbox11 transcripts are rare and are detected only in the pluteus larva and in the Aristotle's lantern and intestine of the adult. The PlHbox12 gene is, on the contrary, transiently expressed in the very early embryo already at the four cell stage; it accumulates at the 64 cell stage and disappears at later stages of development. In situ hybridization experiments to 16 and 32 cell stage whole mount embryos showed localization of the PlHbox12 mRNA to part of the mesomere-macromere region of the early cleavage embryo. These observations suggest a possible role of this gene in early events of cell specification.

Pterygium inversum unguis. Report of 19 cases and review of the literature

BACKGROUND

Pterygium inversum unguis is a rare abnormality of the nail bed that remains adherent to the ventral surface of the nail plate, resulting in a subungual extension of the hyponychium and obliteration of the distal groove.

OBJECTIVE

The aim of our article is to illustrate the cases of pterygium inversum unguis that we observed in the last 20 years and to discuss them according to a broad review of the literature.

RESULTS

Nineteen new cases of pterygium inversum unguis have been observed: one congenital idiopathic form, five acquired idiopathic forms, and 13 secondary forms.

CONCLUSION

Our study and the review of the literature demonstrate that the most common forms of pterygium inversum unguis are the acquired secondary ones. They are generally related to systemic connective tissue diseases and, in particular, to progressive systemic sclerosis and systemic lupus erythematosus.

Sea urchin early histone H2A modulator binding factor 1 is a positive transcription factor also for the early histone H3 gene

To shed some light on the mechanisms involved in the coordinate regulation of the early histone gene set during sea urchin development, we tested the hypothesis that the upstream sequence element USE1, previously identified in the early H2A modulator, could also participate in the transcription of the early histone H3 gene. We found by DNAse I protection analysis and by competition in electrophoretic mobility-shift experiments that two sequence elements of the H3 promoter closely resembled the USE1-H2A sequence in their binding activity for nuclear factors from 64-cell stage embryos. These modulator binding factor 1 (MBF-1)-related factors seem to recognize the ACAGA motif that is conserved between the USE1-like sequences of both H2A and H3 promoters. In fact, excess oligonucleotide containing a mutated USE1-H2A element in which the ACAGA sequence was mutated to AGTCA failed to compete with the USE1 sites of both H2A and H3 genes for interaction with MBF-1. Finally, in vivo transcriptional analysis in both Xenopus and sea urchin showed that an excess of USE1-H2A element efficiently competed for the activity of the H3 promoter. From these results we conclude that MBF-1 is a transcription factor conserved between sea urchin and frog and that MBF-1 or related transcription factors are involved in the coordinate expression of both H2A and H3 early histone genes.

Endometrial carcinoma in tamoxifen-treated breast cancer patients

Tamoxifen is an important agent for the treatment of breast cancer. Occasionally the drug, which is an antiestrogen, has agonistic estrogenic activity. The authors describe three new cases of endometrial carcinoma developing in breast cancer patients taking tamoxifen and stress the necessity of carefully monitoring the uterine cavity under tamoxifen treatment.

Smouldering hepatitis B virus replication in patients with chronic liver disease and hepatitis delta virus superinfection

Hepatitis B virus deoxyribonucleic acid (HBV-DNA) was studied by Southern blot analysis in liver biopsy specimens from 75 HBsAg-positive patients with chronic liver disease living in southern Italy. Twenty-seven of the patients were hepatitis delta virus (HDV) superinfected. Intrahepatic HBV-DNA was detected in 54 (72%) patients, 32 (59%) of them with replicative forms. The presence of replicative forms was directly related to liver HBcAg and inversely related to liver HDAg, as shown by multivariate analysis. However, 14 patients with intrahepatic HBV-DNA non-replicative pattern and about half of HDV-infected patients were liver HBcAg and/or serum HBV-DNA positive, mostly in low amounts. Histological inflammatory activity was strongly related to liver HBcAg expression regardless of HDV superinfection, as confirmed by multivariate analysis. Our results confirm previous studies about the concordance between intrahepatic HBV-DNA replicative pattern and liver HBcAg expression and about inhibition by HDV of high-level HBV replication. However, they suggest that low-level HBV replication may have an important role in causing liver damage also among HDV-infected patients, in a population where the spreading of HBV and HDV is a naturally occurring event.