Moderate alcohol use and health: a consensus document

AIMS

The aim of this consensus paper is to review the available evidence on the association between moderate alcohol use, health and disease and to provide a working document to the scientific and health professional communities.

DATA SYNTHESIS

In healthy adults and in the elderly, spontaneous consumption of alcoholic beverages within 30 g ethanol/d for men and 15 g/d for women is to be considered acceptable and do not deserve intervention by the primary care physician or the health professional in charge. Patients with increased risk for specific diseases, for example, women with familiar history of breast cancer, or subjects with familiar history of early cardiovascular disease, or cardiovascular patients should discuss with their physician their drinking habits. No abstainer should be advised to drink for health reasons. Alcohol use must be discouraged in specific physiological or personal situations or in selected age classes (children and adolescents, pregnant and lactating women and recovering alcoholics). Moreover, the possible interactions between alcohol and acute or chronic drug use must be discussed with the primary care physician.

CONCLUSIONS

The choice to consume alcohol should be based on individual considerations, taking into account the influence on health and diet, the risk of alcoholism and abuse, the effect on behaviour and other factors that may vary with age and lifestyle. Moderation in drinking and development of an associated lifestyle culture should be fostered.

Consumption of healthy foods at different content of antioxidant vitamins and phytochemicals and metabolic risk factors for cardiovascular disease in men and women of the Moli-sani study

BACKGROUND/OBJECTIVES

To categorize healthy food groups into categories of low-antioxidant (LAC) or high-antioxidant vitamins and phytochemicals content (HAC) and comparatively associate them with metabolic risk factors for cardiovascular disease (CVD).

SUBJECTS/METHODS

A total of 6879 women (55±12 years) and 6892 men (56 ± 12 years) were analyzed from the Moli-sani cohort, randomly recruited from the general population. The European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire was used for dietary assessment. The antioxidant content of each food group was evaluated using Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione and United States Department of Agriculture (USDA) food composition tables. Healthy foods, according to a Mediterranean dietary pattern, were categorized into HAC or LAC; total food antioxidant content (FAC) score was constructed for a comparative evaluation of the consumption of these two groups.

RESULTS

In men, an increase in FAC score, which represents an increased consumption of HAC with respect to LAC foods, was associated with a decrease in systolic blood pressure, diastolic blood pressure and C-reactive protein (CRP) (β=-0.5, P=0.02, β=-0.3, P=0.02 and β=-0.03, P=0.03, respectively). Logistic regression analyses showed that in men 15% (30 units) increase in FAC score was associated with 6% decrease in the likelihood of having hypertension (odds ratio (OR)=0.94, 95% confidence interval (CI) 0.91-0.98) and 3% decrease in the likelihood of having a high CRP risk level (OR=0.97, 95% CI 0.94-0.99). No significant associations were observed in women.

CONCLUSIONS

A possible greater protective role of healthy HAC as compared with healthy LAC foods on hypertension and inflammation was detected in men. These results stress the importance of studying healthy foods according to their content in antioxidant vitamins and phytochemicals, in primary prevention of CVD.

Tinnitus sound therapy with open ear canal hearing aids

OBJECTIVE

The aims of this study were to evaluate the efficacy of open ear canal hearing aids in tinnitus treatment and to investigate the influence of gender, age, medication usage, tinnitus cause, tinnitus perception side, tinnitus pitch, pure tone audiometry, distortion product otoacoustic emissions, and minimal masking level on outcome.

METHODOLOGY

One hundred tinnitus patients were evaluated by the tinnitus handicap inventory (THI) at the beginning of the study and after nine months of treatment. All subjects were submitted to counselling and sound enrichment from the simple sound amplification provided by the open ear canal hearing aids.

RESULTS

Initial mean THI score was 54.22 (+/- 20.37) and final mean score was 28.32 (+/- 16.50), p < 0.0001. No statistically significant correlations were found between THI value reduction and the studied parameters.

CONCLUSION

Open ear canal hearing aids were useful in all tinnitus patients with mild hearing loss.

Dietary patterns, cardiovascular risk factors and C-reactive protein in a healthy Italian population

BACKGROUND AND AIMS

Dietary habits have been associated with cardiovascular disease (CVD) risk factors. This study aimed at evaluating the association of non-predefined dietary patterns with CVD risk profile and C-reactive protein (CRP).

METHODS AND RESULTS

We analyzed 7646 healthy subjects from the Moli-sani project, an on-going cross-sectional cohort study of men and women aged >or=35, randomly recruited from a general Italian population. The Italian EPIC food frequency questionnaire was used. Food patterns were generated using principal factor analysis (PFA) and reduced rank regression (RRR). Three dietary patterns were identified by PFA. The "Olive Oil and Vegetables" pattern, characterized by high intake of olive oil, vegetables, legumes, soups, fruits and fish, was associated with relatively lower values of glucose, lipids, CRP, blood pressure and individual global CVD risk score. The "Pasta and Meat" pattern, characterized by high intake of pasta, tomato sauce, red meat, animal fats and alcohol, was positively associated with glucose, lipids, CRP and CVD risk score. The "Eggs and Sweets" pattern, characterized by positive loadings of eggs, processed meat, margarines, butter, sugar and sweets, was associated with high values of CRP. The first RRR pattern was similar to the "Pasta and Meat" pattern both in composition and association with CVD risk profile.

CONCLUSIONS

In a large healthy Italian population, non-predefined dietary patterns including foods considered to be rather unhealthy, were associated with higher levels of cardiovascular risk factors, CRP and individual global CVD risk, whereas a "prudent-healthy" pattern was associated with lower levels.

Absorbable stabilisation of the bar in minimally invasive repair of pectus excavatum

INTRODUCTION

The minimally invasive repair of pectus excavatum has become the preferred technique in most centres. One of the most important technical points for the final result is stabilisation of the bar, usually obtained by one or two metal stabilisers. Recently, long-term absorbable stabilisers have become available (LactoSorb, Biomet, Jacksonville, FL, USA). Made of poly-L-lactic and polyglycolic acid, they have been introduced with the aim of reducing local discomfort and making removal of the bar easier. Their efficacy for the stabilisation of the bar has not been proved yet. In this paper we compare the surgical outcome in two groups of patients, one treated with metallic and the other with absorbable stabilisers.

MATERIAL AND METHODS

A total of 280 patients underwent pectus excavatum repair using a Nuss technique in two centres. In 194 patients (group 1), operated on since 2001, the metallic stabiliser was used. In 86 patients (group 2), operated on since February 2007, the LactoSorb stabiliser was preferred. We compared both groups in terms of surgical details, local symptoms or complications, and bar instability rate.

RESULTS

The surgical technique for the stabilisation of the bar was identical in both groups, but in group 1 the stabiliser was fastened to the bar with a steel wire, while in group 2 polyglycolic sutures were used. No differences in local discomfort or postoperative pain were observed between the groups. The LactoSorb stabiliser was palpable for at least 6-9 months, and progressively disappeared at 9-12 months. In group 1 we observed 6 local complications. In particular, two patients presented with infection, one of them associated with a skin lesion and opening over the metallic stabiliser (revision of the wound was performed). Another patient developed a thoracic wall haematoma after suffering a trauma over the metallic stabiliser, 13 months after operation. Three patients developed a seroma. In group 2 we observed 3 subcutaneous swellings at the site of the LactoSorb stabiliser at 6, 8 and 9 months after the operation. We did not observe either skin lesions or infections. In the group with metallic stabiliser, 3 patients (1.5 %) had bar dislocation, while we did not observe bar instability in the group with LactoSorb stabiliser.

CONCLUSIONS

LactoSorb stabiliser is safe and effective for stabilising the bar in pectus surgery. We suggest its routine use as it appears to be less traumatic and could make bar removal easier.

QTL analysis of late blight resistance in a diploid potato family of Solanum phureja x S. stenotomum

Field resistance to Phytophthora infestans (Mont.) de Bary, the causal agent of late blight in potatoes, has been characterized in a potato segregating family of 230 full-sib progenies derived from a cross between two hybrid Solanum phureja x S. stenotomum clones. The distribution of area under the disease progress curve values, measured in different years and locations, was consistent with the inheritance of multigenic resistance. Relatively high levels of resistance and transgressive segregations were also observed within this family. A genetic linkage map of this population was constructed with the intent of mapping quantitative trait loci (QTLs) associated with this late blight field resistance. A total of 132 clones from this family were genotyped based on 162 restriction fragment length polymorphism (RFLP) markers. The genome coverage by the map (855.2 cM) is estimated to be at least 70% and includes 112 segregating RFLP markers and two phenotypic markers, with an average distance of 7.7 cM between two markers. Two methods were employed to determine trait-marker association, the non-parametric Kruskal-Wallis test and interval mapping analysis. Three major QTLs were detected on linkage group III, V, and XI, explaining 23, 17, and 10%, respectively, of the total phenotypic variation. The present study revealed the presence of potentially new genetic loci in this diploid potato family contributing to general resistance against late blight. The identification of these QTLs represents the first step toward their introgression into cultivated tetraploid potato cultivars through marker-assisted selection.

Mapping genes for resistance to Verticillium albo-atrum in tetraploid and diploid potato populations using haplotype association tests and genetic linkage analysis

Verticillium wilt disease of potato is caused predominantly by Verticillium albo-atrum and V. dahliae. StVe1 -a putative QTL for resistance against V. dahliae -was previously mapped to potato chromosome 9. To develop allele-specific, SNP-based markers within the locus, the StVe1 fragment from a set of 30 North American potato cultivars was analyzed. Three distinct and highly diverse haplotypes can be distinguished at the StVe1 locus. These were detected in 97%, 33%, and 10% of the cultivars analyzed. We tested for haplotype association and for genetic linkage between the StVe1 haplotypes and resistance of tetraploid potato to V. albo-atrum. Moreover, field resistance was assessed in diploid populations with known molecular linkage maps in order to identify novel QTLs. Resistance QTLs against V. albo-atrum were detected on four chromosomes (2, 6, 9, and 12) at the diploid level, with one QTL on chromosome 2 contributing over 40% to the total phenotypic variation of the trait. At the tetraploid level, a significant association between the StVe1-839-C haplotype and susceptibility to the disease was detected, suggesting that resistance-related genes directed against V. albo-atrum and V. dahliae are located in the same genomic region of chromosome 9. However, on the basis of the present analysis, we cannot determine whether these genes are closely linked or if a single gene provides resistance against both Verticillium species. To assess the usefulness of the StVe1-839-C haplotype for marker-assisted selection, we subjected the resistance data to Bayesian analysis, and calculated positive (0.65) and negative (0.75) predictive values, and overall predictive accuracy (0.72). Our results indicate that tagging of additional genes for resistance to Verticillium with molecular markers will be required for efficient marker-assisted selection.

Mapping genes for resistance to Verticillium albo-atrum in tetraploid and diploid potato populations using haplotype association tests and genetic linkage analysis

Verticillium wilt disease of potato is caused predominantly by Verticillium albo-atrum and V. dahliae. StVe1 -a putative QTL for resistance against V. dahliae -was previously mapped to potato chromosome 9. To develop allele-specific, SNP-based markers within the locus, the StVe1 fragment from a set of 30 North American potato cultivars was analyzed. Three distinct and highly diverse haplotypes can be distinguished at the StVe1 locus. These were detected in 97%, 33%, and 10% of the cultivars analyzed. We tested for haplotype association and for genetic linkage between the StVe1 haplotypes and resistance of tetraploid potato to V. albo-atrum. Moreover, field resistance was assessed in diploid populations with known molecular linkage maps in order to identify novel QTLs. Resistance QTLs against V. albo-atrum were detected on four chromosomes (2, 6, 9, and 12) at the diploid level, with one QTL on chromosome 2 contributing over 40% to the total phenotypic variation of the trait. At the tetraploid level, a significant association between the StVe1-839-C haplotype and susceptibility to the disease was detected, suggesting that resistance-related genes directed against V. albo-atrum and V. dahliae are located in the same genomic region of chromosome 9. However, on the basis of the present analysis, we cannot determine whether these genes are closely linked or if a single gene provides resistance against both Verticillium species. To assess the usefulness of the StVe1-839-C haplotype for marker-assisted selection, we subjected the resistance data to Bayesian analysis, and calculated positive (0.65) and negative (0.75) predictive values, and overall predictive accuracy (0.72). Our results indicate that tagging of additional genes for resistance to Verticillium with molecular markers will be required for efficient marker-assisted selection.

Linkage disequilibrium mapping of a Verticillium dahliae resistance quantitative trait locus in tetraploid potato ( Solanum tuberosum) through a candidate gene approach

We have used the linkage disequilibrium mapping method to test for an association between a candidate gene marker and resistance to Verticillium dahliae in tetraploid potato. A probe derived from the tomato Verticillium resistance gene ( Ve1) identified homologous sequences ( StVe1) in potato, which in a diploid population map to chromosome 9, in a position analogous to that of the tomato resistance gene. When a molecular marker closely linked (1.5 cM) to the homologues was used as a candidate gene marker on 137 tetraploid potato genotypes (mostly North American cultivars), the association between the marker and resistance was confirmed ( P<0.001). The amount of phenotypic variation in resistance explained by the allele of the STM1051 marker was greater than 10% and 25% in two subpopulations that were inferred from coancestry data matrix. Cloning of homologues from the highly resistant potato cv. Reddale indicates that the resistance quantitative trait locus (QTL) comprises at least an eleven-member family, encoding plant-specific leucine-rich repeat proteins highly similar to the tomato Ve genes. The sequence analysis shows that all homologues are uninterrupted open reading frames and thus represent putative functional resistance genes. This is the first time that the linkage disequilibrium method has been used to find an association between a resistance gene and a candidate gene marker in tetraploid potato. We have shown that it is possible to map QTL directly on already available potato cultivars, without developing a new mapping population.

Linkage disequilibrium mapping of a Verticillium dahliae resistance quantitative trait locus in tetraploid potato ( Solanum tuberosum) through a candidate gene approach

We have used the linkage disequilibrium mapping method to test for an association between a candidate gene marker and resistance to Verticillium dahliae in tetraploid potato. A probe derived from the tomato Verticillium resistance gene ( Ve1) identified homologous sequences ( StVe1) in potato, which in a diploid population map to chromosome 9, in a position analogous to that of the tomato resistance gene. When a molecular marker closely linked (1.5 cM) to the homologues was used as a candidate gene marker on 137 tetraploid potato genotypes (mostly North American cultivars), the association between the marker and resistance was confirmed ( P<0.001). The amount of phenotypic variation in resistance explained by the allele of the STM1051 marker was greater than 10% and 25% in two subpopulations that were inferred from coancestry data matrix. Cloning of homologues from the highly resistant potato cv. Reddale indicates that the resistance quantitative trait locus (QTL) comprises at least an eleven-member family, encoding plant-specific leucine-rich repeat proteins highly similar to the tomato Ve genes. The sequence analysis shows that all homologues are uninterrupted open reading frames and thus represent putative functional resistance genes. This is the first time that the linkage disequilibrium method has been used to find an association between a resistance gene and a candidate gene marker in tetraploid potato. We have shown that it is possible to map QTL directly on already available potato cultivars, without developing a new mapping population.

Epidemiological profile of symptomatic osteoarthritis in older adults: a population based study in Dicomano, Italy

OBJECTIVES

To assess the prevalence of hand, hip, and knee osteoarthritis (OA) in an older Italian community dwelling population and its association with disability.

METHOD

A cross sectional survey of the whole community aged 65 years and over, was carried out in Dicomano, a small rural town in Tuscany, Italy. Subjects were screened by geriatricians for major chronic conditions, including hip, knee, and hand OA, using diagnostic algorithms based on the American College of Rheumatology (ACR) clinical criteria. A rheumatologist examined subjects who screened positive. Disability was assessed by a World Health Organisation questionnaire.

RESULTS

697 of 864 eligible subjects (81% of the eligible population) were screened. OA of the knee, hand, or hip was identified by clinical ACR criteria respectively in 159, 139, and 81 subjects, and was confirmed by the rheumatologist in 158/182 (87%), 75/101 (74%), and 63.2% of cases. The estimated prevalence was 29.8%, 14.9%, and 7.7%, respectively. Only hip OA was significantly associated with disability in basic activities of daily living.

CONCLUSIONS

About one third of community dwelling older people are affected by symptomatic peripheral OA. Hip OA was strongly associated with disability.

Adsorption of the organic fraction of a tannery sludge by means of organophilic bentonite

Two different organophilic bentonites obtained by cationic exchange with benzyldimethyloctadecylammonium chloride and trimethyloctadecylammonium chloride have been used to adsorb the organic fraction of a tannery sludge. The exchange process was carried out to different extents to obtain bentonite samples with different organophilicities and different interlayer spacings. Before adsorption, the organic matter was extracted by contacting the sludge with a Ca(OH)2 saturated solution. The adsorption capacity was found to increase with the amount of ammonium salt exchanged for both bentonites, but the one exchanged with benzyldimethyloctadecylammonium chloride proved to be more active: up to about 80% TOC could be removed from the contacting solution. The adsorption of the organic matter caused a further increase of the bentonite interlayer spacing. In both cases, the adsorption isotherms were found to be of cooperative type, due to weak adsorbent-adsorbate interactions at low loading followed by increasing adsorbate-adsorbate interactions at increasing loading. The results may be applied to tannery sludge stabilization by cementitious systems.

Characterization of Cu,Zn superoxide dismutase from the bathophile fish, Lampanyctus crocodilus

Cu,Zn SOD from the bathophile teleost Lampanyctus crocodilus (LSOD) shows a high degree of homology with the sequence of the enzymes from other teleostean fish species. The catalytic properties of LSOD are very similar to those of the bovine enzyme, albeit with higher sensitivity to thermal denaturation. The apparent molecular mass of LSOD (37.6 KDa) is higher than the other Cu,Zn SOD variants studied. The aminoacid sequence of LSOD reveals interesting substitutions compared to the bovine enzyme. These are discussed in view of the particular environmental conditions to which L. crocodilus is adapted.

Identification of the residues responsible for the alkaline inhibition of the activity of Cu,Zn superoxide dismutase: a study of native and chemically modified enzymes

The pH dependence of the activity of Cu,Zn superoxide dismutases from bovine erythrocytes and shark liver was studied by pulse radiolysis in both the native enzymes and those chemically modified at lysine side chains. The study was aimed at identifying the residues responsible for the activity decrease at pH > 9, observed in all native Cu,Zn superoxide dismutases, and is based on the Lys-->Arg substitution present in the shark protein at position 134, which has been established to be critical for the catalytic efficiency of the enzyme. Both native enzymes display a pH dependence that can be deconvoluted by three deprotonation equilibria, at pH 9-9.5 (pK1), at pH 10.2 (pK2), and at pH 11.5 (pK3). pK1 is lacking in both the modified enzymes and thus can be assigned to activity-linked lysine residues. pK2 is clearly dominated by Arg134 in the modified shark enzyme and can be assigned to surface arginine residues. pK3 is shared by all four enzyme forms and is likely to be due to the invariant Arg141.

Relationship between health status, fluid intelligence and disability in a non demented elderly population

This study examines the impact of overall health status and common chronic medical conditions on cognitive performance in an older population and the effect of poor cognitive performance on functional disability. The study population consisted of 485 subjects who were 77 and 78 years old, and residing in district No. 6 of the city of Florence; all participants underwent a structured interview to collect information on demographics, education, physical health, disability, and cognitive status. Data from 94 subjects, who were previously diagnosed as affected by dementia or other conditions known to be direct causes of cognitive impairment, and from 6 subjects, who scored less than 20 in the Mini-Mental State Examination, were excluded from the analysis. The number of chronic conditions, drugs used, contacts with the physician, days in bed, and days of hospitalization in the last 6 months were considered as indicators of physical health. Functional disability was assessed evaluating both ADLs and IADLs. The Mini-Mental State and the "Blocks" test, a component of the Wechsler Adult Intelligence Scale Revised, were used for the assessment of cognitive status. After adjusting for the level of formal education, physical health status and several specific chronic conditions were predictors of cognitive performance. A significant association was found between a low "Blocks" test score and a decreased level of functional status. In a multivariate model, better performance on the "Blocks" test was associated with a higher score in the disability scale. This association was independent of the effect of education. The results suggest that in the elderly, poor health status is associated with a cognitive impairment that can be measured by the "Blocks" test. However, the role of this association in the pathway from disease to disability remains unclear.

[Hypnosis and cancer: a working hypothesis. Initial notes]

Hypnosis has been used to resolve stress and anxiety following profound psychological-behavioural changes occurring in the cancer sufferer from the moment of diagnosis. It is stated that hypnosis is useful in improving sick persons' quality of life through the control of stress reactions, simplification of treatment and facilitation of rehabilitation, both within the family and socially. Through deep seated psycosomatic interconnections, psychological attitude can affect organic reaction to all disease, cancer included.

[Complications observed in the radiosurgical management of cervical cancer (author's transl)]

Radiosurgical management, using 192Ir instead of radium, was carried out in 58 cases of cervical cancer. The complications are described and discussed on relation to the dose employed.

[Technical modification of moulds construction for gynecological curietherapy (author's transl)]

The authors describe a new, faster and less-laborious method of moulds construction for gynecological curietherapy.

[Endocavitary radiotherapy of carcinoma of the cervix uteri using a modeled device and Ir-192. Computerized dosimetry]

A computerised dosimetry programme for use in intracavitary radiotherapy of cervical carcinoma using a shaped after-loading apparatus and 192Ir wires is described. The technique for its use is explained and the results observed are discussed.