Liposome-based gene delivery systems containing a steroid derivative: computational and small angle X-ray diffraction study

The structural properties and the phase behaviour of mixed composition liposomes containing a functionalized lipid are investigated with the aim to design neutral liposomes able to coordinate metals and to complex DNA.

Antitoxin use and pediatric intensive care for viper bites in Rome, Italy

In Italy viper bites represent an uncommon event, though envenomation can cause severe complications, more in children than adults, because of dose/body size ratio. We present a case series within a selected population: 10 Italian cases (from Rome surroundings) of viperbites requiring PICU admission, over a 5-year interval. Five children showed a systemic involvement, whereas the remaining patients showed a damage. All were managed and closely monitored in an ICU setting. Relevant clinical findings and therapeutic approach, ICU course and complications have been recorded. Age range was 3-15 years with mean age of 6,9 (SD±4,58) years; 2 patients needed respiratory support beyond oxygen supplementation. Most patients underwent fluid loading, while hemodynamic support was given to4/10. Median PICU stay was 60 hours (IQR=24.0-75.5). No mortality was reported. Indications and precautions for administration of antivenom in the last years have been reviewed: early treatment seems to reduce mortality/morbidity, though representing a threat for children. Current recommendations for the treatment of viper envenomation have been described, based on a literature's review and the application of these knowledges to clinical reality of our PICUs. Therefore, paediatric patients with systemic or rapidly evolving symptoms should be monitored carefully for the development of bite-related complications in an ICU setting mostly in younger children.

Liposomes containing mannose-6-phosphate-cholesteryl conjugates for lysosome-specific delivery

We present a novel liposomal nanocarrier containing mannose 6-phosphate-cholesteryl conjugates and show its ability to reach the lysosomes by means of confocal and fluorescence microscopy measurements.

Exposure assessment of mycotoxins in cow's milk in Argentina

A stochastic simulation model was developed to carry out the first quantitative risk exposure assessment of the mycotoxin level in cow's milk produced in Argentina. The prevalence and concentration of aflatoxin M1 (AFM1), deoxynivalenol (DON) and zearalenone (ZEA) were modeled at various stages through milk processes complying with Argentinean practices. Concentration of AFM1 (0.059ppb), DON (0.338ppb) and ZEA (0.125ppb) in dairy milk were estimated. The proportion of feed samples that exceeded the maximum level accepted by European regulations for AFB1, DON and ZEA were estimated at 25.07%, 0.0% and 8.9%, respectively. The percentage of milk samples that exceeded the maximum level accepted for AFB1 by the MERCOSUR (0.5ppb) and the European Union regulations (0.05ppb) were 0.81 and 32.65, respectively. The probability distribution of AFM1 concentration in milk was affected by the carry-over rate equations applied in the model. Mycotoxin levels in corn silage and concentrated feeds were the factors most correlated with mycotoxin concentrations in milk. Therefore, agricultural practices, crop management and feed production require prompt attention regarding mycotoxin issues.

Elevated serum ALT in children presenting to the emergency unit: Relationship with NAFLD

BACKGROUND

Non-alcoholic fatty liver disease, ranging from hepatic steatosis to necro-inflammation with or without fibrosis (non-alcoholic steatohepatitis), is a growing clinical liver disorder in children.

AIM

The goals of this study were to characterize liver disorders associated with elevated aminotransferases and establish the non-alcoholic fatty liver disease/non-alcoholic steatohepatitis prevalence in hypertransaminasemic children admitted to the emergency room.

METHODS

The medical records of 3280 children (2-17 years of age) admitted to the emergency room of Bambino Gesù Children's Hospital of Rome, and presenting with hypertransaminasemia were analysed retrospectively.

RESULTS

Elevation of serum alanine aminotransferases was present in 897 patients. Of these, 520 (58%) spontaneously normalized alanine aminotransferases, and 179/897 (20%) maintained persistently elevated alanine aminotransferases levels. Twenty-one patients were excluded because of medication or alcohol use. In the remaining 157 patients with elevated alanine aminotransferases, obesity was found in 87 (55%), viral infections in 52 (33%) and genetic diseases in 14 (9%). Obesity-related alanine aminotransferases elevation was associated with a histological diagnosis of non-alcoholic fatty liver disease in 85% of patients. In particular, steatosis was histologically confirmed in 74 patients; 43/74 (58%) had steatohepatitis, and 12/74 (16%) had fibrosis.

CONCLUSIONS

Twenty percent of children with elevated aminotransferases on routine testing may hide non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. A careful diagnostic workup of persistent hypertransaminasemia in all obese subjects is warranted in the paediatric setting.

Effects on platelet function of combination etoposide and carboplatin chemotherapy in pediatric oncology patients

The effects of a therapeutic course of the combination of carboplatin and etoposide on platelet function have been evaluated in 10 pediatric patients with brain tumors. Platelet count, in vitro aggregation tests, P-selectin expression and agonist-induced ATP release were evaluated before, and 7 and 15 days after one cycle of chemotherapy. The analysis of the results demonstrated the presence of an in vitro platelet aggregation defect in response to collagen and arachidonic acid in all patients 7 days after therapy. A concomitant decrease of collagen- and arachidonic acid-induced ATP release was also observed. Both platelet aggregation and ATP release returned to baseline values 15 days after chemotherapy administration. Conversely, in vitro platelet aggregation and secretion induced by ADP and epinephrine were unaltered by carboplatin and etoposide administration. Furthermore, P-selectin expression was negative at baseline and did not change after chemotherapy. These results support the hypothesis that combination etoposide and carboplatin chemotherapy in pediatric patients is responsible for possible disturbances in biochemical pathways required for platelet secretion and aggregation.

Abdominal pain and wandering spleen in young children: the importance of an early diagnosis

PURPOSE

The aim of the study is to increase clinical awareness of torsion of wandering spleen (WS) in childhood and the need of a rapid diagnosis.

METHODS

Four cases operated for torsion of WS are retrospectively reviewed. Ages at presentation were, respectively, 30 months, 5 years, 4 years, and 3 years, without sex preference. All subjects led a history of abdominal pain and a mass on physical examination.

RESULTS

Torsion of WS should be suspected in any child presenting with acute abdomen. Moreover, in case of acute abdomen and intermittent abdominal pain, we suggest studying spleen position with ultrasound.

CONCLUSIONS

Ultrasonography with color Doppler is the best choice for diagnosis of torsion of WS. Computed tomography is a good complementary examination, but it needs to submit young patients to a general anesthesia and delays an emergency situation.

Role of regional mechanical dyssynchrony as a determinant of functional mitral regurgitation in patients with left ventricular systolic dysfunction

OBJECTIVE

To assess regional mechanical dyssynchrony as a determinant of the degree of functional mitral regurgitation (FMR).

SETTING

Tertiary cardiology clinic.

PATIENTS

74 consecutive patients with left ventricular (LV) dysfunction (ejection fraction < 40%, mean 32.2 (SD 7.3)%) were evaluated.

METHODS

Effective regurgitant orifice (ERO) area, indices of mitral deformation (systolic valvular tenting, mitral annular contraction) and of global LV function and remodelling (ejection fraction, end systolic volume, sphericity index) and local remodelling (papillary-fibrosa distance, regional wall motion score index), and tissue Doppler-derived dyssynchrony index (DI) (regional DI, defined as the standard deviation of time to peak myocardial systolic contraction of eight LV segments supporting the papillary muscles attachment) were measured.

RESULTS

All the assessed variables correlated significantly with ERO. By multivariate analysis, systolic valvular tenting was the strongest independent predictor of ERO (R(2) = 0.77, p = 0.0001), with a minor influence of papillary-fibrosa distance (R(2) = 0.77, p = 0.01) and regional DI (R(2) = 0.77, p = 0.03). Local LV remodelling (regional wall motion score index: R(2) = 0.58, p = 0.001; papillary-fibrosa distance: R(2) = 0.58, p = 0.002) and global remodelling indices (sphericity index: R(2) = 0.58, p = 0.003) were the main determinants of systolic valvular tenting, whereas regional DI did not enter into the model. Regional DI was an independent predictor of ERO (R(2) = 0.56, p = 0.005) in patients with non-ischaemic LV dysfunction but not in patients with ischaemic LV dysfunction when these groups were analysed separately.

CONCLUSIONS

The degree of FMR is associated mainly with mitral deformation indices. The regional dyssynchrony also has an independent association with ERO but with a minor influence; however, it is not a determinant of FMR in patients with ischaemic LV dysfunction.

Histological and microscopy FT-IR imaging study on the proliferative activity and angiogenesis in head and neck tumours

Micro Fourier transform infrared spectroscopy enables one to study small samples because of the high quality spectra that can be obtained. Biochemical and morphological changes between control and pathological tissues of head and neck tumours have been monitored drawing three-dimensional chemical maps of the main vibrational modes in the regions of interest. Comparison between spectral and histological data shows a satisfactory degree of accordance. Among all, proliferating and regressive states of the tumours can be identified.

[Ultrasonography of normal vermiform appendix]

The aim of this study was the detection and visualisation of the normal vermiform appendix and its characteristics by ultrasonography in adults with no clinical suggestion of acute or chronic abdominal disease. A prospective study was performed in 200 subjects. The graded-compression ultrasonography technique was used to explore the lower right quadrant of the abdomen and the pelvis. The examination was performed using a 4 MHz sector array and 7.5 MHz linear array transducer. In a few cases, a 10 MHz linear array transducer was used. The appendix was visualized in 54% of patients. In all cases where the appendix was visualized it was found to be either on the ileo-psoas muscle or directly beneath the abdominal wall. The ileo-caecal valve was visualized in 78% of cases. The transverse diameter was found to be no greater than 6.5 mm except in three cases that had a diameters ranging from 7 to 9 mm. Diameter variability along the length of the same appendix was demonstrated in 5% of subjects. Wall thickness was no greater than 2.5 mm. Our experience suggests that graded-compression ultrasonography is a valuable procedure for detecting the vermiform appendix more frequently than has been previously reported. The patients physical constitution and the anatomical location of the vermiform appendix were found to be important factors affecting the ability to visualize the vermiform appendix. The ability to visualise the normal vermiform appendix ultrasonographically supports the clinical diagnosis and excludes acute appendicitis.

A sample scanning system with nanometric accuracy for quantitative SPM measurements

A sample scanning device operating in a working volume of 30 x 30 x 18 microm with interferometer and capacitance-based controls of displacements, is described. The xy-stage uses plane mirror linear interferometers and fast phase-meters for control of displacements of precise ball-bearing stages driven by piezo flexure actuators. The stage operates with a full range bandwidth of 200 Hz, and an estimated accuracy (k = 2) of 3 nm + 1 x 10(-3) L, where L is the lateral displacement. A novel z-stage based on a kinematic coupling between two plates, the upper one being moved by three bimorph plates and the distance being measured by three capacitive sensor, is described. The tilt of the z-stage is kept within fractions of a microrad, leading to a full range estimated accuracy of 2 nm + 2 x 10(-3) h, where h is the vertical displacement. The control bandwidth is of about 1 kHz, thus allowing fast and accurate step-height measurements. In order to test the device used in a scanning probe microscope, micrometric patterned surfaces made using high resolution e-beam lithography and precise metal deposition on silicon are imaged. Results of pitch measurements are discussed and compared with those obtained using optical diffractometry.

[Mottled hyperpigmentation of the fundus oculi associated with angioid streaks in pseudoxanthoma elasticum]

The Authors report mottled fundus in association with pseudoxanthoma elasticum in 8 of 9 patients. The mottled hyperpigmentation is an early uncommonly described finding, consisting of a speckled, yellowish mottling of the posterior pole temporal to the macula at ophthalmoscopic examination; this appearance, called "peau d'orange", is believed to be caused by changes in the retinal pigmented epithelium overlying a calcified and degenerating Bruch's membrane. This finding is virtually pathognomonic of pseudoxanthoma elasticum and may be present even in the first decade of the disease, prior to the appearance of the angioid streaks. The Authors emphasize the significance of the retinal finding, that may represent an incomplete genetic expression of an autosomal recessive carrier state.

[A case of idiopathic hypereosinophilic syndrome]

Idiopathic hypereosinophilic syndrome (IHS) is reported in a 59-year-old farmer. Skin manifestations were represented by pruritic erythemato-squamous and papulonodular lesions, the heart was affected by endomyocardic fibrosis, and periodic intestinal colics denoted a possible gut involvement. A mild and transient beneficial effect was achieved by treatment with antihistamines, sodium-chromoglycate, steroids. Recent studies indicate that IHS hypereosinophilia is caused by interleukins 3 and 5, cytokines able to activate circulating eosinophils and to enhance the survival of these cells.