Post-polio syndrome: clinical manifestations and cerebrospinal fluid markers

Post-polio syndrome (PPS) refers to a constellation of new neurological, musculoskeletal and general symptoms occurring in survivors of poliomyelitis decades after acute paralytic and nonparalytic disease. The common manifestations of PPS include generalized, central and peripheral fatigue, muscle weakness and musculoskeletal pain. The pathogenesis of PPS remains obscure. Three prevailing hypotheses have been advanced: stress-induced degeneration of surviving neurons, persistent poliovirus replication or virus reactivation and immune-mediated damage. The diagnosis of PPS is based on medical history and clinical examination, since no specific diagnostic tests are available. In the light of recent studies demonstrating a partial beneficial effect of intravenous immunoglobulin, this article will focus on cerebrospinal fluid biomarkers reflecting disease activity and pathogenic processes in PPS.

Virology of the post-polio syndrome

The three poliovirus serotypes (PVs) cause acute paralytic poliomyelitis. Decades after being hit by polio, survivors may develop a condition known as post-polio syndrome (PPS). PPS is characterized by extreme fatigue, progressing muscular weakness and chronic pain. The pathogenesis is unclear and, thus, empirical therapies are employed. PVs are known to be able to persist in infected host cells both in vitro and in vivo. The understanding of PV genomes has made it possible to set up sensitive and specific molecular tests capable of detecting minute amounts of virus in samples from PPS patients. Current data indicate that complete PV genomes (or genomic fragments) remain present, decades after acute paralysis, in the CNS of these patients. Virus persistence is hypothesized to bring about chronic inflammation, immune-mediated injury and decreased expression of neurotrophic factors. Establishing a pathogenetic link between PV persistence and PPS would be extremely relevant to the development of an etiologic therapy aimed at virus eradication.

Culture of skeletal myoblasts from human donors aged over 40 years: dynamics of cell growth and expression of differentiation markers

Background

Local myogenesis, neoangiogenesis and homing of progenitor cells from the bone marrow appear to contribute to repair of the infarcted myocardium. Implantation into heart tissues of autologous skeletal myoblasts has been associated with improved contractile function in animal models and in humans with acute myocardial ischemia. Since heart infarction is most prevalent in individuals of over 40 years of age, we tested whether culture methods available in our laboratory were adequate to obtain sufficient numbers of differentiated skeletal myoblasts from muscle biopsy specimens obtained from patients aged 41 to 91.

Methods and results

No matter of donor age, differentiated skeletal muscle cells could be produced in vitro in amounts adequate for cellular therapy (≥300 millions). Using desmin as a cytoplasmic marker, about 50% cultured cells were differentiated along myogenic lineages and expressed proteins proper of skeletal muscle (myosin type I and II, actin, actinin, spectrin and dystrophin). Cytogenetic alterations were not detected in cultured muscle cells that had undergone at least 10 population doublings. Molecular methods employed for the screening of persistent viral infections evidenced that HCV failed to replicate in muscle cells cultured from one patient with chronic HCV infection.

Conclusion

The proposed culture methods appear to hold promise for aged patients not only in the field of cardiovascular medicine, but also in the urologic and orthopedic fields.

Proliferative activity of extracellular HIV-1 Tat protein in human epithelial cells: expression profile of pathogenetically relevant genes

Background

Tat is being tested as a component of HIV vaccines. Tat activity has been mainly investigated on cells of lymphoid/hematopoietic lineages. HIV-1, however, is known to infect many different cells of both solid organs and mucosal surfaces. The activity of two-exon (aa 1–101) and synthetic (aa 1–86) Tat was studied on mammary and amniotic epithelial cells cultured under low serum conditions.

Results

small concentrations of Tat (100 ng/ml) stimulated cell proliferation. Tat antibodies neutralized the mitogenic Tat activity. Changes of gene expression in Tat-treated cells were evaluated by RT-PCR and gene-array methods. Within 4 hours of treatment, exposure to Tat is followed by up-regulation of some cell cycle-associated genes (transcription factors, cyclin/cdk complexes, genes of apoptotic pathways) and of genes relevant to HIV pathogenesis [chemokine receptors (CXCR4, CCR3), chemotactic cytokines (SDF-1, RANTES, SCYC1, SCYE1), IL6 family cytokines, inflammatory cytokines, factors of the TGF-beta family (TGFb, BMP-1, BMP-2)]. Up-regulation of anti-inflammatory cytokines (IL-10, IL-19, IL-20), a hallmark of other persistent viral infections, was a remarkable feature of Tat-treated epithelial cell lines.

Conclusion

extracellular Tat is mitogenic for mammary and amniotic epithelial cells and stimulates the expression of genes of pathogenetic interest in HIV infection. These effects may favor virus replication and may facilitate the mother-to-child transmission of virus.

Poliovirus type 1 infection of murinePRNP-knockout neuronal cells

Transfection of the prion protein gene (Prnp) into prion-deficient mouse cells was shown to reduce the replication of coxsackievirus B3, an enterovirus. Because mice can be susceptible to poliovirus infection by parenteral routes, the authors tested the susceptibility to poliovirus-1 (PV-1) of a panel of murine neuronal cell lines differing in their ability to express Prnp. The investigated cell lines (prionless HpL3.4 cells, HpL3.4 cells transfected with a Prnp vector, HpL3.4 cells transfected with a void vector, wild-type Hw3.5 Prnp(+/+) cells) expressed the murine homologue (Tage4) of human poliovirus receptor (CD155/hPVR). PV-1 infection of Prnp(-/-) HpL3.4 cells resulted in the production of high viral titers, though viral antigens could be detected in only 0.5% to 2% of cells. Wild-type Prnp(+/+) cells and prionless cells transfected with the Prnp gene were not permissive to PV-1. Results of viral titration and immunofluorescence were confirmed by conventional polymerase chain reaction (PCR) and quantitative real-time PCR. Exposure to PV-1 had no influence on the gene expression profile of Prnp(+/+) cells. In contrast, PV-1 infection was associated with upregulation of several genes in permissive Prnp(-/-) cell cultures: type I interferon (IFN) genes, IFN-related developmental regulator 1 (IFNRD1), tumor necrosis factor superfamily member 13b (TNFSF13b), interleukin (IL) - 7, granulocyte/macrophage colony-stimulating factors (CSFs), hepatocyte growth factor (HGF), vascular endothelial growth factor-A, transforming growth factors beta1 and beta3 (TGFb1, TGFb3), as well as a variety of bone morphogenetic proteins endowed with neuroprotective activity. Distinction of permissive from nonpermissive neuronal cells on the basis of Prnp expression suggests that prion-deficient mice could represent an extraordinarily sensitive animal model for poliovirus infection.

[Determination of interleukin-8 in induced sputum of workers exposed to low concentrations of asbestos]

The concentration of interleukin-8 (IL-8) in the induced sputum of 17 workers exposed to low airborne asbestos levels and of 10 controls was determined. IL-8 levels were statistically significantly increased in the asbestos exposed group compared to controls. This finding underlines the usefulness of the study of proinflammatory mediators as possible predictors of alveolar damage.

Iliac crest free flap in oromandibular reconstruction. 13 cases study

Oromandibular reconstruction following oncological resection is particularly challenging. In this past decade, great improvements have been made, in functional and aesthetic terms, following the introduction of composite free flaps. By means of this reconstructive technique, it is, in fact, possible to restore mandibular continuity, and, consequently, the morphology of the lower third of the face; rehabilitate mastication through osteointegrated implants, and optimise the reconstruction of soft tissue, employing the fascio-cutaneous or muscular portion of these flaps. Between January 1995 and January 2001, 70 oromandibular reconstructions employing osseous free flaps were performed in the Department of Maxillo-Facial Surgery of the Ospedale Maggiore in Parma, and in 13 of these the iliac crest free flap was used. Personal experience is described regarding the indications and use of this flap.

Human immunodeficiency virus-1 tat induces hyperproliferation and dysregulation of renal glomerular epithelial cells

Human immunodeficiency virus-associated nephropathy (HIVAN) is etiologically related to the viral infection, but the mechanisms of virus-induced renal injury remain undetermined. Peculiar histopathological features of HIVAN are the enhanced proliferation and the loss of differentiation markers of glomerular epithelial cells (podocytes). We found that podocytes were not permissive to HIV-1 replication. In this study we investigated the effects of the HIV-1 regulatory protein Tat on primary cultures and on a continuous line of podocytes. Our results demonstrated that Tat induced hyperproliferation of these cells in a dose-dependent manner. This activity was primarily mediated by the basic domain of the viral protein. Proteoglycans were required for this phenomenon because Tat-induced increase of podocyte growth was significantly impaired by inhibition of proteoglycan synthesis with beta-D-xyloside. In podocyte cultures Tat promoted both the transcription and the release of basic fibroblast growth factor, which contributed to the enhanced cell proliferation. Moreover, Tat deregulated the podocyte phenotype causing down-regulation of maturity markers such as WT-1 and synaptopodin, alteration of cytoarchitecture, and impairment of permselectivity. Together, these results demonstrate that the interaction of extracellular Tat with podocytes can induce alterations that mimic the pathological changes of podocytes detected in HIVAN.

Blood lead reference values: the results of an Italian polycentric study

This paper presents the results of a polycentric study carried out in seven different areas, organized by the Italian Society of Reference Values (SIVR) for assessing reference values of lead in blood (B-Pb) at the current doses of the metal to general population. The estimated arithmetic mean for B-Pb in males was of 45.1 microg/l and 30.6 microg/l in females; the 95th centile was 100 and 60 for males and females, respectively. The main variables influencing B-Pb levels were gender, age, BMI, outside sport practice, alcohol consumption and smoking habits, while the geographic area and the urban residence did not affect the metal concentration in blood.

[Arteriovenous malformations of the head and neck. Diagnosis and methods of treatment]

BACKGROUND

After a review of the literature, the results of a clinical study carried out on cases of extracranial arteriovenous malformations of the head and neck, are reported.

METHODS

Thirteen patients with extracranial arteriovenous malformations of the head and neck have been treated at the Maxillofacial Department of the University of Parma from 1995 to 2000. Five patients observed the onset in childhood, five in adolescence and three in adulthood. Arteriovenous malformations have been classified according to Schobinger's clinical staging. Four patients with superselective embolization, one with surgical resection and the remaining eight with superselective embolization followed by radical en bloc resection have been treated. The follow-up period varied from 2 to 5 years.

RESULTS

No relapses have been observed in the cases treated with surgical resection and with superselective embolization followed by radical excision. Only 1 patient treated by superselective embolization had a good outcome. This treatment can be a good palliative in the treatment pain and bleeding particularly when surgical excision would result in mutilation or disfigurement, nevertheless it is necessary a careful follow-up since the lesion treated only by superselective embolization can grow quickly and begin bleeding and aching again.

CONCLUSIONS

In personal experience, according to the literature, embolic/surgical management of arteriovenous malformations is not always the treatment of choice. On the basis of clinical characteristics of the lesions, different kinds of treatments (embolization, resection, embolization followed by resection) may be chosen to obtain favorable RESULTS.

[Occupational medicine in Desio: the hygiene and industrial toxicology laboratory--evolution of the activities in the last 10 years]

During last decade the analytical work of industrial toxicology and hygiene laboratory of the occupational medicine department of Desio Hospital (UOOML) developed towards more sophisticated and specialized techniques. This change required an updating and an increase of the analytical instruments and a continuous training of the laboratory staff, usually achieved by the incomes of the department. With this consideration in mind, we recognize the need for evaluating the laboratory activity by "indices" more susceptible of the qualitative aspect of the activity rather than the quantitative aspect.

Plasma or whole blood concentrations of trace elements in patients treated by haemodiafiltration with on-line prepared substitution fluid

Large membrane pores and large quantities of reinfusion fluids can influence the dialytic balance of trace elements in haemodiafiltration (HDF). As there are no studies in HDF with on-line produced reinfusate, we studied plasma or whole blood (*) concentrations of trace elements (Al, Cd*, Cr* and Se: microg/l; Cu, Pb* and Zn*: microg/dl) of 24 on-line HDF, 20 haemodialysis (HD) patients and 66 490 normal subjects (N). The concentrations of Al (11.7+/-9.5), Cd (0.73+/-0.59) and Cr (6.5+/-6.9) were significantly greater in on-line HDF patients than in normal subjects (6+/-0.4; 0.6+/-0.2; 0.5+/-0.02), but similar to those of HD patients. In on-line HDF patients, Cu (85.3+/-17.7), Pb (8+/-4.6), Se (68+/-27) and Zn (546+/-103) concentrations were less than in normal subjects (108+/-3.4; 11+/-0.8; 95+/-1.8; 673+/-23), and those of Cu and Zn were also less than in HD patients (99.5+/-16.8; 670+/-65). At the end of an on-line HDF treatment (42-69 studies), there was a significant increase in Al (from 12.8+/-9.1 to 15.4+/-8.3), Cr (from 7.2+/-6.4 to 9.5+/-7), Cu (from 97.3+/-21.5 to 109.4+/-27.2) and Zn (from 577+/-108 to 619+/-117). A longitudinal study (n = 16-18) for 12-30 months documented stable concentrations of Al, Cd, Cr, Se and Zn and a significant increase of Cu and Pb to normal concentrations. In conclusion, our on-line HDF patients have elevated Al, Cd, Cr and decreased Cu, Pb, Se, Zn concentrations in plasma or whole blood determinations. Cu and Pb normalize with time; the other trace elements remain stable as documented by numerous determinations. As the values for on-line HDF patients are similar to those of HD patients, the level of accumulation or depletion of trace elements in on-line HDF can be considered as safe as in HD; the increase in Al, Cd, Cu and Zn at the end of treatment may be an expression of the increase of those trace elements linked to proteins.

Trace elements and micropollutant anions in the dialysis and reinfusion fluid prepared on-line for haemodiafiltration

Exposure to the trace elements and micropollutions of tap water may be very considerable in dialysis patients. As few data on trace elements in reinfusion and dialysis fluid for haemodiafiltration (HDF) have been reported, we studied nine trace elements (microg/l; Al, As, Cd, Cr, Cu, Hg, Pb, Se, Zn) and five anions (mg/l; F-, NO2-, NO3-, PO4(3-), SO4(2-)) in tap water, in water after two passages of reverse osmosis (2RO), in dialysate and in on-line prepared reinfusate. NO3- and SO4(2-) were somewhat elevated in our tap water (22.2+/-7.6 and 21.8+/-11.3 mg/l) but decreased (P<0.001) after 2RO (1.4+/-1.5 and 0.9+/-1.1 mg/l); the other anions, which were at a very low level, remained unchanged. All trace elements decreased, with statistical significance only for Al, Cr and Zn from 14.9+/-19.9, 2.6+/-0.6 and 35.1+/-41.1 microg/ to 3.2+/-2.1, 0.2+/-0.2 and 3.5+/-4.8 microg/l, respectively. Due to impurities in concentrate salts for Al (5.4+/-3.1), Cr (0.5+/-0.4) and SO4(2-) (2.4+/-1.8), greater concentrations were found in dialysate and reinfusate than in tap water after 2RO (P<0.03). For all measurements, trace elements and anions were at acceptable levels according to international standards. Simultaneous determinations of trace elements at inflow (Din) and outflow (Dout) of the dialysate as well as in plasma or in whole blood at the beginning of on-line HDF documented Dout/Din>1 for Al, Cu and Zn and a positive gradient between the concentration in blood and dialysate inlet. In conclusion, our dialysate and reinfusate can be considered safe regarding trace elements and micropollution: two passages through reverse osmosis reduces the concentrations of trace elements and anions. The impurities of concentrates are acceptable. Accumulation or depletion of trace elements should be evaluated after longitudinal studies of plasma concentrations.

Cobalt exposure in wet grinding of hard metal tools for wood manufacture

The authors examined exposure to cobalt during the wet grinding of hard metal tools (Widia tools) used in the wood industry, usually in small specialized workshop which can produce exposure to cobalt > TLV-TWA (50 micrograms/m3) if carried out with no protective devices. Local exhausts near the grinding wheel can reduce the exposure to cobalt by as much as 20 times. Nevertheless, some technical problems often hamper the effectiveness of these protective devices, so that the plant situation, examined by the forecasting OTL test as proposed by Tuggle (Am. Ind. Hyg. Assoc. J., 43 (1982) 338), does not appear to be completely acceptable. Other technical solutions are therefore necessary for a complete control of the exposure to cobalt. A more effective water stream, a greater air velocity near the grinding wheel and a protective shield between the wheel and the worker are some suggestions.

[Measurements and environmental and biological monitoring of occupational exposure to inhalation anesthetics]

This paper reports the data of nitrous oxide (N2O) environmental pollution in 269 operating rooms of 47 hospitals in Italy in 1989-91. In 40% of the operating rooms the N2O concentrations are lower than 50 ppm, limit value proposed by Health Council for new operating rooms. In 65.4% of the operating room studied, N2O mean environmental concentrations are lower than 100 ppm, value proposed by the above-mentioned Health Council as limit value for the already existing operating rooms. Concerning the biological monitoring, the authors report several N2O data in urine (2193), whose levels confirm the data obtained with environmental monitoring. The authors believe that they presently have reliable methods to perform biological and environmental monitoring: the two techniques are complementary in the assessment of the exposure. The method of measuring N2O concentrations as exposure index, both for the environmental and biological monitoring, is considered very useful to simplify the performance of the analyses. In order to assess exposure more precisely, it is however necessary also to determine the environmental and/or biological measure of the other different anaesthetics used.

A new tool for sampling airborne isocyanates

A new sampling system is presented that uses solid sorbent media contained in a tube for the determination of airborne isocyanates (2.4-2.6 toluene diisocyanate, hexamethylene diisocyanate, and 4.4' diaminodiphenylmethane diisocyanate). The method is compared with the National Institute for Occupational Safety and Health (NIOSH) Method P&CAM 5505 (Revision #1). Experimental tests yielded results that were highly concordant with the NIOSH method.